Provider Contracting Advisor
Posted on: March 28, 2020
This position serves as an integral member of the Provider
Contracting Team and reports to the Provider Contracting Senior
Manager. 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.DUTIES AND
- 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
- 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.
- Manages strategic positioning for provider contracting,
develops networks and identifies opportunities for greater
value-orientation and risk arrangements.
- 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
- 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
- Creates HCP 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
- 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
- Should possess a bachelor degree; preferably in the areas of
Finance, Economics, Healthcare or Business related. Significant
industry experience will be considered in lieu of a Bachelor
degree. MBA or MHA preferred.
- Three to five years contracting and negotiating experience
involving complex delivery systems and organizations required.
- Experience in developing and managing key provider
- 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 managerial courage as well as 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.About CignaCigna
Corporation (NYSE: CI) is a global health service company dedicated
to improving the health, well-being and peace of mind of those we
serve. We offer an integrated suite of health services through
Cigna, Express Scripts, and our affiliates including medical,
dental, behavioral health, pharmacy, vision, supplemental benefits,
and other related products. Together, with our 74,000 employees
worldwide, we aspire to transform health services, making them more
affordable and accessible to millions. Through our unmatched
expertise, bold action, fresh ideas and an unwavering commitment to
patient-centered care, we are a force of health services
innovation.When you work with Cigna, youll enjoy meaningful career
experiences that enrich peoples lives while working together to
make the world healthier place. What difference will you make? To
see our culture in action, search #TeamCigna on Instagram.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 an accommodation based on your physical or mental
disability please email: SeeYourself@cigna.com. Do not email
SeeYourself@cigna.com for an update on your application or to
provide your resume as you will not receive a response.
Keywords: Cigna, Charlotte , Provider Contracting Advisor, Other , Charlotte, North Carolina
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