"Alerted.org

POSITIOIN SUMMARY

The Program Management Advisor is part of an innovative team who have overall accountability for reimbursement policy creation, maintenance, and project support. This individual will partner with many areas including Prepay, Business Operations, and other matrix partners to assist with the implementation of reimbursement policies.

The Program Management Advisor will demonstrate critical thinking, an ability to work well in a fast-paced, team-based environment, both independently and partnering with other business areas to make solid, well-informed decisions based on data and multiple inputs to achieve business objectives.

Provides expert content/professional leadership in relation to coding and reimbursement intent. Exercises considerable creativity, foresight, and judgment in conceiving, planning, and delivering initiatives. Uses deep professional knowledge and acumen to advise others. Recognized internally as a subject matter expert

Knowledge and experience with claims data and Cigna's claims systems are a plus. Advantages of this position include a positive team atmosphere, cooperative business partners and work/life balance.

Candidates who reside within 50 miles of the following locations may be required to perform onsite 3 days per week: Bloomfield, CT; Chattanooga, TN; Denver, CO; St Louis, MO; and Scottsdale, AZ.

Primary Responsibilities

+ Execute responsibility for the identification of reimbursement policy opportunities, policy maintenance, and project work associated with the policies

+ Detailed research for the competitor landscape to identify current industry trends, and creation of code edit strategies to align with reimbursement policies

+ Manage the policy maintenance for evaluation of industry changes, code additions, revisions, and/or deletions associated with reimbursement policy and code edits

+ Execute the ability to review data analytics to identify and validate reimbursement policy opportunities

+ Maintain and document clear coding logic and data requirements for matrix partners

+ Author and maintain reimbursement policy language, coding, and templates

+ Present reimbursement policy summary for applicable governance

+ Become the subject matter expert (SME) on existing and development of new reimbursement policy

+ Execute clear communication, be collaborative, while working effectively and efficiently with other matrix partners

Key Qualifications

+ Bachelor’s degree in Healthcare, Nursing or related curriculum preferred

+ Active AAPC or AHIMA coding certification required e.g., CPC, CCS-P, CIC, or COC, with a minimum of 5 years procedure coding (HCPCS/CPT) experience required

+ At least 5 years’ healthcare insurance claim editing/analysis background required

+ Strong attention to detail to include ability to analyze claim data analytics

+ Proficient at documenting necessary coding/billing requirements for code editing

+ Excellent business writing skills

+ Facility and/or coding certification(s) or billing experience a plus

+ Medicare coding and/or reimbursement experience preferred

+ Must be proactive, and team oriented with an ability to foster collaboration

+ Value others’ perspectives for successful implementation of organizational projects

+ Proven ability to prioritize multiple tasks in a fast-paced environment

+ Strong communication (oral and written), presentation, and facilitation skills

+ Effective analytical and problem-solving skills

+ Passionate regarding quality of work

+ Proficiency in Microsoft Office software

rev 10/3/2025

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 93,300 - 155,500 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:_ [email protected]_ _for support. Do not email_ [email protected]_ _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._