Reimbursement Policy & Payment Integrity Leader

Role Summary:

The RP/PI Managing Director is a strategic leadership position within Cigna Healthcare responsible for strategy and resource planning, performance oversight, and value governance with a specific focus on reimbursement policy and payment integrity functions and related capabilities. 

• Market competitive intelligence assessment related to payor and provider reimbursement trends. (inclusive of competitive gap assessment.
• Overall management of reimbursement policy value creation processes: .
  • Oversight payment trends, coordinate RCA and define strategic and tactical solutions with business leaders as necessary 
  • Convening internal and external stakeholders to develop strategy and opportunity pipeline
  • Business case development of identified opportunities with oversight accountability for prioritizing portfolio of initiatives
  • Convenes cross functional clinical, operational and contracting partners to ensure successful design and implementation of identified opportunities.
  • Business owner of technology investment and related capabilities (including vendor management as necessary).
  • Monitoring and reporting on the performance and impacts of RP/PI Policy changes.
  • Communication(s) management, development and maintenance of payment policies (both internal and external).
  • When necessary coordinate opportunities that may be better served via alternative delivery mechanism (e.g. contracting, medical management, etc.)
• Works in close partnership with payment integrity operations, clinical policy, analytics, and technology teams
• Member of the Affordability leadership team, responsible for Cigna’s Healthplan affordability strategy, roadmap, and value delivery.   
• Directly manages baseline funding pool to allocate funds to functional teams needed to deliver prioritized initiatives and responsible business leader for oversight and feature prioritization for $15M in capability investments.
• Directly manages a team of business leaders and analysts with direct responsibility for talent recruitment, hiring, training and development of team members. 
• Key resource for workflow connectivity & interoperability between Cigna and providers

Qualifications and Experience:

• Deep understanding and experience in the healthcare industry and marketplace.
• Degree in finance, economics, analytics, healthcare economics, or healthcare management.  Advanced degree preferred. 
• Systems, data and operational understanding and background.
• Experience in financial modelling and healthcare economics and analytics.
• Minimum of 5 years in the healthcare industry with experience in claim payment and administration.   At least 5 years of team management.
• Ability to partner and engage with business leaders and clinical experts both external and external and operational and technology teams.
• Prior experience working in a matrixed organization and leading a large-scale governance process and structure is preferred.

Competencies Required for the Role:

• Strategic Mindset
• Cultivates Innovation
• Courage
• Drive Results
• Communicates Effectively
• Ensures Accountability
• Strong Collaboration and Partnership

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.

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: [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.