Cigna Healthcare
Healthcare
ProviderContractingAdvisor
Neural analysis suggests this role is
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“Provider Contracting Advisor at Cigna Healthcare. Skills: Provider contracting, Network management, Negotiations. Manage contracting negotiations. Negotiate fee for service reimbursements”
What You'll Achieve.
Achieve competitive position; Maintain competitive position
Industry & Context.
Problem solving skills; Decision making skills
Live in Tennessee
What They're Looking For.
Must Have
Bachelor's degree in Finance, Economics, Healthcare, or Business, 3+ years Managed Care contracting experience, 3+ years negotiating complex delivery systems, 3+ years negotiating complex organizations, Experience developing provider relationships, Experience managing provider relationships, Experience building external relationships, Experience nurturing external relationships, Experience with hospital business models, Experience with managed care business models, Experience with provider business models, Ability to influence sales audiences, Ability to influence provider audiences, Knowledge of Microsoft Office tools
Nice to Have
MBA or MHA preferred, Knowledge of complex reimbursement methodologies, Knowledge of incentive based models preferred
What You'll Do.
Manage contracting negotiations
Negotiate fee for service reimbursements
Negotiate value-based reimbursements
Build provider partnerships
Seek value-based business opportunities
Initiate communication with matrix partners
Maintain communication with matrix partners
Contribute to alternative network initiatives
Provide direction for network analytics
Meet unit cost targets
Preserve adequate network
Create initiatives to improve medical cost
Create initiatives to improve quality
Assess clinical informatics
Offer consultative expertise
Assist with medical cost initiatives
Prepare financial impact of contracts
Analyze financial impact of contracts
Review financial impact of contracts
Project financial impact of contracts
Create healthcare provider agreements
Ensure accurate implementation
Ensure accurate administration
Resolve elevated provider complaints
Resolve complex provider complaints
Research provider problems
Negotiate with internal partners
Negotiate with external partners
Manage key provider relationships
Interface with providers
Interface with business staff
Demonstrate knowledge of providers
Understand competitive landscape
Ensure timely contract loading
Ensure timely contract submissions
Interface with matrix partners for network implementation
Interface with matrix partners for network maintenance
Provide guidance to specialists
Provide expertise to specialists
How You'll Work.
Team & Collaboration
Communication with matrix partners; Interface with providers; Interface with business staff
Communication Scope
Written communication; Verbal communication; Formal presentations
Full Job Description
**WORK LOCATION: will need to live in Tennessee** The **Provider Contracting Advisor (Director, Network Management)** serves as an integral member of the Provider Contracting Team and reports to the **Provider Contracting Sr. Manager** (**AVP, Network Management).** 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 RESPONSIBILITIES_** * 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. Researche
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