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.
Provider Contracting Advisor
Location
United States + 9 moreAll locations: United States | United Kingdom | Canada | Germany | France | India | Brazil | Australia | Estonia | Japan
Posted
33 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Provider Contracting Advisor
The Cigna Group
Role Description The Provider Contracting Advisor serves as an integral member of the Provider Contracting Team and reports to the AVP, Provider Contracting. This role assists in developing the strategic direction and management of the day-to-day contracting and network management activities for a local given territory. - Manages complex contracting and negotiations for fee-for-service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups). - Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities to support the local market strategy. - Initiates and maintains effective channels of communication with matrix partners including but not limited to Claims Operations, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing, and Service. - Contributes to the development of alternative network initiatives. Supports and provides direction to develop network analytics required for the network solution. - Works to meet unit cost targets while preserving an adequate network to achieve and maintain Cigna's competitive position. - Creates and manages initiatives that improve total medical cost and quality. - Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives. - Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms. - Creates healthcare provider agreements that meet internal operational standards and external provider expectations. Ensures the accurate implementation and administration through matrix partners. - Assists in resolving elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues. - Manages key provider relationships and is accountable for critical interface with providers and business staff. - Demonstrates knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape. - Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance. - May provide guidance or expertise to less experienced specialists. Qualifications - Bachelor’s degree; preferably in Finance, Economics, Healthcare, or Business related. Significant industry experience will be considered in lieu of a bachelor’s degree. - MBA or MHA preferred. - 3+ years Managed Care contracting and negotiating experience involving complex delivery systems and organizations required. - Experience in developing and managing key provider relationships. - Knowledge of complex reimbursement methodologies, including incentive-based models strongly preferred. - Demonstrated experience in seeking out, building, and nurturing strong external relationships with provider partners. - Intimate understanding and experience with hospital, managed care, and provider business models. - Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization. - The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations. - Customer centric and interpersonal skills are required. - Demonstrates an ability to maneuver effectively in a changing environment. - Superior problem-solving, decision-making, negotiating skills, contract language, and financial acumen. - Knowledge and use of Microsoft Office tools. Requirements - If working from home, internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. Equal Opportunity Statement 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. 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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