Non-Par Provider Contracting Advisor - Washington
3 days ago
Job description
Provides subject-matter expertise for Cigna's Out-of-Network (OON) Protection Programs, including the Network Savings Program (NSP) and Bill Negotiation Services (BNS). Serves as a shared service supporting all Cigna platforms in achieving OON goals.
Oversees program administration across multiple claim systems and acts as the primary expert on NSP and BNS, including the impact of federal and state surprise billing laws on claim workflows. Ensures vendor compliance, advises leaders and matrix partners, and provides thought leadership within the Out-of-Network Protection Team while supporting broader cross-functional initiatives.
Key Responsibilities
- Track and trend PMHS program performance; partner with Service Operations to resolve pricing, finalization, and adjustment issues
- Coordinate resolution of aged and outstanding vendor claims
- Support development and maintenance of Reason, Remark, and Explanation codes across all claim engines; maintain active and sunset code lists
- Develop and maintain vendor reconciliation processes to ensure accurate claim processing and fee billing
- Manage vendor fee reimbursement processes, including configuration, changes, and exceptions
- Partner with ONPT teams to identify and implement process and system improvements
- Develop and maintain procedural documentation in collaboration with Service Operations, Compliance, Legal, and claim engine teams
- Lead quarterly SOX audit reviews and responses to demonstrate control adherence
Qualifications
- Bachelor's degree preferred
- Minimum 10 years of industry experience
- Strong knowledge of claims engines and out-of-network / non-PAR programs
- PMHS claim engine experience required; ProClaim and Facets preferred
- Data analysis experience using tools such as TOAD, SAS, or SQL preferred
- Strong communication skills with the ability to translate complex concepts for non-technical audiences
- Healthcare industry experience required; OON expertise strongly preferred
- Proven analytical, technical, and business acumen
- Ability to work independently and collaboratively in matrixed environments
- Demonstrated ability to drive change and improve process efficiency
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, 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), 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, click here.
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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: for support. Do not email 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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