Cigna

  • New York City, NY

    Connecticut


  • Permanent

  • Full-time
ORGANIZATION OVERVIEW:

Cigna (NYSE: CI) is a global health service company dedicated to helping people improve their health, well-being and sense of security. All products and services are provided exclusively through operating subsidiaries of Cigna Corporation, including Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Life Insurance Company of North America and Cigna Life Insurance Company of New York. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy and vision care benefits, and other related products including group disability, life, and accident coverage. Cigna has sales capability in 30 countries and jurisdictions, with approximately 75 million customer relationships throughout the world.

POSITION SUMMARY:

Location: This role is remote, work at home

The Operations Director, Provider Education leads Cigna’s Medicare Risk Adjustment Quality Operations team. This role identifies and applies best practices and processes and drives improvements to ensure efficacy and accuracy across Medicare Risk Adjustment programs through Provider Education and data quality oversight. Identifies and recommends both strategic and tactical improvements to these processes, and ensures compliance to all applicable laws, guidance, and regulations. Collaborates with key business partners in the development and management of a robust reporting package and drives actionable insights through reporting & analytics. Maintains systems & processes that support Risk Adjustment operational goals.

Collaborates with stakeholders on project planning, risk mitigation, vendor management, contingency planning and execution to ensure delivery of expected outcomes. Supports and oversees special projects as needed to drive business value. Regularly engages with executive leadership and matrixed organizations through all stages of strategy, project planning and execution, to ensure delivery of expected outcomes.

This individual will be specifically responsible to:

  • Lead, inspire and grow Cigna’s Risk Adjustment Quality Operations team. Be fully accountable of Cigna’s Risk Program Operations and create a culture of continuous process improvement, quality and efficiencies.
  • Lead all Risk Adjustment Provider Education teams responsible for providing guidance and education relative to Cigna’s Medicare Risk Adjustment and documentation programs, including direct oversight of regional Provider Education Managers across the entire Cigna Medicare segment.
  • Coordinate closely with Data Quality Medical Director and other leaders to develop, maintain and improve educational documentation and Risk Adjustment policy.
  • Develop, Maintain and/or update policies and procedures to ensure compliance across all processes.
  • Oversees team responsible for data integration with key provider partners to promote efficient transfer of Risk Adjustment related data.
  • Collaborate and influence matrix partners across the enterprise to ensure end-to-end compliance with Coding Best Practices and established compliance guidelines.
  • Partner with market leadership to develop local strategies to improve penetration of Prospective and Retrospective Risk Adjustment programs in order to achieve key strategic business goals.
  • Advocate for regulatory change that drives improvement to the overall Risk Adjustment Programs and encourage open communication with key governmental partners.

QUALIFICATIONS:

  • 8-12 years or more prior experience with a Health Plan and/or ACO managing risk adjustment for Medicare Advantage (MA) or Individual Medical business lines (MA experience strongly preferred)
  • Position requires at least five years of experience with Risk Adjustment in a Leadership Role (managing other individuals and teams)
  • Demonstrated competencies in Risk Adjustment and Coding from operational, financial and regulatory perspectives
  • Demonstrated success in improving Risk Adjustment measures, managing multiple vendor relationships and leading cross-functional teams
  • Experience with actuarial, finance and/or operational activities of a health plan
  • Demonstrated success leading cross-functional teams.
  • Ability to prioritize tasks with competing deadlines and collaborate with key business partners in a matrix environment

EDUCATION:

  • Bachelor’s Degree strongly desired, Preferred field of study: business, math, finance, economics, actuarial science, healthcare administration or other related health care field

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.

When you work with Cigna, you’ll enjoy meaningful career experiences that enrich people’s lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

Cigna

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