Provider Contracting Advisor - Cigna Healthcare - Remote

WORK LOCATION

will need to live within the defined territory:
Alabama

• Manages complex contracting and negotiations for fee for service and value-based reimbursements (e.g., Hospital systems, Ancillaries, and 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.

• Bachelor's Degree Preferred; preferably in the areas of Finance, Economics, Healthcare or Business related.
• 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 strongly preferred.
• 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.
• 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 10
  
  Mbps download/5
  
  Mbps upload.

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