Provider Contracting Director-West Region (Remote)

Cigna Healthcare•Arizona Work at Home, AZ

3d•$156,700 - $261,100•Remote

About The Position

The Provider Contracting Director-West Region is responsible for ensuring field contractors adhere to contracting standards, including the use of current core contracts, reimbursement standards, network and contract policy, and the provider contract escalation and review process. This role provides guidance and support to field contractors on national standards and the Contract Management System, assisting with non-standard issues and collaborating with the National Contracting Standards & Policy team on policy, language, and "ability to administer" issues, as well as reporting and compliance with the exception review process.

Requirements

7+ years in Medical Contracting, Negotiating and Provider Services
Ability to foster collaboration, value others perspectives and gain support and buy-in for organizational proposals
Matrix management skills.
Ability to drive and lead an organization through change.
Excellent interpersonal and relationship management skills.
Excellent oral, written and presentation skills required.
Strong collaboration, negotiation and leadership skills.
Strong organizational and analytical skills that result in conclusive recommendations.
Ability to think critically with respect to improvement of end-to-end business process
Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Responsibilities

Overall accountability for ensuring that field contractors comply with contracting standards, including use of current core contracts, reimbursement standards, network and contract policy, and the provider contract escalation and review process.
Provide guidance and support to field contractors on national standards and use of the Contract Management System.
Supports field contractors on non-standard issues and works closely with the National Contracting Standards & Policy team on policy, language, and "ability to administer" issues as well as on reporting and compliance with the exception review process.
Work with contractor to develop appropriate response and/or contractual language that does not jeopardize Cigna's contracts with employers, internal policies or standards. Any language request which could have adverse impact to Cigna is brought to Contracting Regional Vice President (RVP) for discussion and intervention with the provider, if necessary.
Ensure required documentation is complete prior to signature by RVP or Market Lead.
Facilitate internal and external audit requirements.
Ensures members of field contracting team receive appropriate and continuous training in all aspects of contracting standards, including use of current, appropriate, core contract templates; preferred reimbursement standards; national network and contracting policy; and the standard contract process.
Ensures understanding and compliance by field contractors with the standard contract process and review of all exceptions to "ability to administer", financial objectives, policies, and language.
Provides consultative support to field contractors on contracting, policy and procedural issues as needed.
Supports field contracting in maximizing use of system.
Ensure all new employees receive the appropriate training.
Monitors Contract Manager usage in accordance with the established guidelines.
Develop contract language and rate exhibit options for field use.
Collaborates with other RDs, Network Analytics Unit and other national functions such as claim operations, medical management, and legal to share best practices and devise creative solutions to complex problems.
Works with national groups to continually review and improve the SARU (Satisfactory, Acceptable, Review- able and Unacceptable) contract standards for all contract types.
Partners closely with US Medical Network Contracting Readiness to ensure policies and standards are communicated to the field staff appropriately.
Works closely with Standards & Policy Committee to identify and resolve issues requiring cross- functional solutions, policymaking and communication.
Provides input and support to national projects (e.g. new product roll-outs, regulatory compliance initiatives, etc.) requiring contract content reviews, language compliance assessments and/or network participation assessments.
Works with local contract teams on language remediation initiatives.