Ppc Consulting Jobs in Colorado (NOW HIRING)

Candidates who reside within 50 miles of the following locations may be asked to work in person three days per week: Bloomfield, CT, Chattanooga, TN, Denver, CO, St Louis, MO, or Scottsdale, AZ.

Program Management Senior Advisor, Payment Policy and Coding Business Implementation Lead (BIL)

Role Description:

The Program Management Senior Advisor (Band 4, Individual Contributor) is a senior operational leader responsible for ensuring the accurate, compliant, and high-quality execution of regulatory driven alignment across reimbursement rules, prior authorization, and medical policy implementation. This role translates complex regulatory, legal, and policy requirements into disciplined execution, bringing structure to ambiguity and driving coordinated delivery across highly matrixed, cross functional teams.

As the Business Implementation Lead (BIL) of the Payment Policy and Coding team (PPC) you will act as the point person within the PPC business segment responsible for managing and coordinating the implementation process to ensure compliance of coverage, reimbursement, administrative, and code editing policy. This position is responsible for driving awareness, assessment and implementation of new federal and state laws, which includes reviewing impacts of new and revised compliance instructions and mandates and how it translates to policy implementation. The BIL will work cross functionally with affordability implementation partners and within the PPC along with other BILs as necessary and maintain a close partnership with Regulatory and Compliance teams.

Additional principal functions of this role include:

• Providing compliance awareness and project management support for the Payment Integrity organization.
• Developing quarterly compliance reports for the leadership team.
• List management and process improvement of biomarker coding
• Affordability Project Compliance support - 50 state compliance review to evaluate project impacts and compliance risk tied to editing
• Preventive Workgroup and Committee compliance alignment and consultation support
• Partner with various clinical leads as necessary to address policy related compliance matters
• Partner with the enterprise Legal/ Compliance organization as needed for PPC compliance matters.

This role requires a great level of autonomy, independent critical thinking and flexibility to drive creative approaches and solutions to root cause analysis and problem solving, employing a wide range of methods, tools, and techniques to achieve optimal cross functional efficiencies and the strategic objectives of the PPC. Responsibilities include leading and delivering on cross operational initiatives, clinical governance analysis and operational work stream(s) support. This position will drive development and maintenance of compliance implementation action plans, outcomes and tracking/reporting with the ability to monitor progress against goals, timely escalation of barriers to success along with identification of potential solutions.

Key Duties and Responsibilities:

• Review weekly Regulatory Instructions (RIs), assess applicability and impact across Payment Integrity (PI) and Payment Policy and Coding (PPC), and identify questions, risks, or implementation considerations for discussion with Regulatory and Compliance partners.
• Participate in weekly Law Forum and Implementation Forum discussions; engage the State Regulatory Manager, Compliance Manager, New Law Implementation Lead, and other partners to support timely interpretation, planning, and execution of regulatory requirements.
• Lead coordination of cross-functional implementation activities by identifying appropriate SMEs, aligning impacted teams, and partnering with other BILs when new laws create cross-business dependencies or sequencing considerations.
• Develop, manage, and track implementation action plans, deliverables, timelines, controls, and evidence of compliance, including documentation in OpenPages where RI records are maintained.
• Identify barriers to implementation, evaluate alternative solutions, escalate risks or issues as appropriate, and provide ongoing communication to ensure obstacles are addressed and required support is in place.
• Coordinate compliance-related requirements and deliverables across applicable implementation vehicles, including ClaimsXten, Prepay, Precertification, Pricing, benefit classing, claim engine logic, and related operational processes.
• Maintain information and list management functions for biomarker-related activities and support ongoing compliance alignment for related coding and policy work.
• Build and maintain effective working relationships across Payment Integrity, Payment Policy and Coding, Legal, Compliance, Product, Operations, IT, and other internal customer groups to support aligned and sustainable implementation outcomes.

Qualifications:

• Bachelor's degree or higher strongly preferred.
• 7+ years of program or product management experience working within a complex, regulated environment, with a focus on compliance and regulatory implementation highly preferred.
• Strong knowledge of health plan operations, regulatory processes, and compliance requirements highly preferred.
• Cigna experience preferred.
• Experience implementing regulatory mandates and supporting audits, inquiries, disputes, policies, procedures, references, or training in regulated settings is required.
• Compliance certification preferred, such as CHC, CPCO, CHPC, or CCEP.
• Proficiency with compliance facilitation and business tools, including iComply, OpenPages, Q&A Fast Map, Law Exchange, Microsoft Office, Tableau, and Wrike.
• Skilled in leading cross-functional initiatives across Legal, Compliance, Product, Policy, Operations, IT, and other matrixed teams.
• Demonstrated ability to work independently, prioritize effectively, and drive high-quality, sustainable results in ambiguous or changing environments.
• Strong business acumen with the ability to quickly understand new business areas, assess impacts, and translate requirements into actionable plans.
• Proactive, team-oriented collaborator with the ability to build credibility, foster alignment, value diverse perspectives, and gain support across organizational levels.
• Excellent written and verbal communication skills, including the ability to produce executive-level and regulator-facing materials.

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 116,100 - 193,500 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.

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, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.