Provider Contracting Advisor - Cigna Healthcare

Cigna Healthcare•Baltimore, MD

1d•$92,000 - $153,300•Remote

About The Position

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 managing commercial contract negotiations and activities for a local given territory. The Provider Contracting Advisor will manage complex contracting and negotiations for fee for service and value-based reimbursements (e.g., Hospital systems, Ancillaries, and physician groups). They will build relationships that nurture provider partnerships and seek broader value-based business opportunities to support the local market strategy. This role will initiate and maintain 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. The Advisor will contribute to the development of alternative network initiatives and support and provide direction to develop network analytics required for the network solution. They will work to meet unit cost targets, while preserving an adequate network, to achieve and maintain Cigna's competitive position. The Advisor will create and manage initiatives that improve total medical cost and quality. They will drive change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives. The Advisor will prepare, analyze, review, and project the financial impact of larger or complex provider contracts and alternate contract terms. They will create healthcare provider agreements that meet internal operational standards and external provider expectations and ensure the accurate implementation and administration through matrix partners. The Advisor will assist in resolving elevated and complex provider service complaints, research problems and negotiate with internal/external partners/customers to resolve highly complex and/or escalated issues. They will manage key provider relationships and be accountable for critical interface with providers and business staff. The Advisor will demonstrate knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape. They will be 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.

Requirements

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 10Mbps download/5Mbps upload.

Nice To Haves

MBA or MHA preferred.

Responsibilities

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.