Cigna Healthcare
Healthcare
ProviderContractingAdvisor
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Provider Contracting Advisor at Cigna Healthcare. Skills: Provider contracting, Negotiations, Provider relationships. Manage contracting negotiations. Manage negotiation activities”
What You'll Achieve.
Meet unit cost targets; Preserve adequate network; Achieve competitive position; Improve total medical cost; Improve quality
Industry & Context.
Problem solving; Decision-making; Negotiating skills
Live within territory
What They're Looking For.
Must Have
Bachelor's Degree, 3+ years Managed Care contracting, 3+ years negotiating experience, Experience developing provider relationships, Experience managing provider relationships, Experience seeking external 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, Experience with formal presentations, Customer centric skills, Interpersonal skills, Ability to maneuver effectively, Superior problem solving skills, Superior decision-making skills, Superior negotiating skills, Superior contract language skills, Superior financial acumen, Knowledge of Microsoft Office tools
Nice to Have
MBA or MHA preferred, Knowledge of complex reimbursement methodologies preferred, Incentive based models knowledge preferred
What You'll Do.
Manage contracting negotiations
Manage negotiation activities
Build provider partnerships
Seek value-based opportunities
Initiate communication channels
Maintain communication channels
Contribute to network initiatives
Support network analytics development
Provide direction for analytics
Meet unit cost targets
Preserve adequate network
Achieve competitive position
Create cost initiatives
Create quality initiatives
Drive change with providers
Assess clinical informatics
Offer consultative expertise
Assist with cost initiatives
Prepare financial impact
Analyze financial impact
Review financial impact
Project financial impact
Create provider agreements
Ensure accurate implementation
Ensure accurate administration
Resolve provider complaints
Negotiate with partners
Negotiate with customers
Resolve complex issues
Resolve escalated issues
Manage provider relationships
Interface with providers
Interface with business staff
Demonstrate provider knowledge
Understand competitive landscape
Ensure timely contract loading
Ensure timely submissions
Interface with matrix partners
How You'll Work.
Team & Collaboration
Matrix partners; Sales and Marketing; Claims Operations; Medical Management; Credentialing; Legal; Medical Economics; Compliance; Service
Communication Scope
Written communication; Verbal communication; Formal presentations
Full Job Description
**WORK LOCATION: will need to live within the defined territory: Maryland, Virginia or DC** 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. **_DUTIES AND 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
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