Medicare Advantage Provider Directory Operations and Accuracy Senior Manager - Cigna Healthcare - Remote

OVERVIEW
The Senior Manager of Medicare Advantage Provider Directory Operations and Accuracy will oversee the accuracy of the provider directory for Medicare Advantage plans, in line with industry standards and CMS (Centers for Medicare & Medicaid Services) regulations. The ideal candidate will lead cross-functional teams in tracking and forecasting directory accuracy, as well as managing internal audits and external vendors to ensure that data in the provider directory is high-quality and up-to-date.

KEY RESPONSIBILITIES:

Directory Accuracy and Quality Assurance:

• Oversee the maintenance and auditing of provider data to ensure accurate information on specialties, locations, network participation, contact information, and other key attributes.
• Develop and implement processes to ensure the accuracy of provider data, including regular audits of provider directory and sourcing of high-quality data from providers and third-party vendors.
• Collaborate with internal teams (e.g., provider relations, audit team, IT) and manage external vendors (e.g., research teams, call centers, data providers) to resolve discrepancies and maintain accurate data.
• Manage the continuous improvement of internal teams and external vendors to streamline processes, reduce errors, and ultimately enhance the accuracy of directory data.
• Ensure consistent and up-to-date provider information across platforms.

Reporting and Analytics:

• Develop and oversee the reporting framework to track and forecast key metrics related to directory accuracy.
• Generate and present regular reports to senior leadership, identifying trends, challenges, and areas for improvement.
• Use data insights to recommend changes and improvements to directory operations, ensuring directory accuracy.

Cross-functional Collaboration:

• Partner with other teams (e.g., provider relations, sales, marketing) to ensure timely and accurate updates to the directory.
• Coordinate with compliance, legal, and regulatory teams to address any provider directory-related issues that may arise in audits or regulatory reviews.

Team Leadership and Development:

• Lead, coach, and develop a team of provider directory specialists and analysts, fostering a culture of collaboration, accountability, and continuous improvement.
• Set performance goals for the team and ensure the achievement of key operational metrics related to directory accuracy, timeliness, and member satisfaction.
• Provide ongoing training and support to ensure staff are knowledgeable about industry best practices and CMS requirements.

QUALIFICATIONS

• Bachelor’s degree in healthcare administration, business, data management, or a related field. A Master’s degree is preferred. 
• 5+ years of experience in provider directory operations, network management, and/or healthcare data management. Experience with Medicare Advantage is preferred. 
• Experience managing offshore teams and/or external vendors. 
• Experience leading cross-functional teams (with business and technical expertise) and managing large, complex projects related to healthcare data and operations. 
• Strong analytical skills with expertise in data management, quality assurance, external vendor management, and/or audit processes. 
• Strong leadership skills, with experience managing teams in a dynamic, fast-paced environment. 
• Excellent communication and collaboration skills, with the ability to work with both technical and non-technical stakeholders. 
• Proficiency in healthcare data tools and platforms (e.g., Excel, database management systems). 
• Knowledge of CMS guidelines and regulatory requirements for Medicare Advantage provider directories. 
   

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 107,800 - 179,600 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

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.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

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