Provider Contracting Advisor - Cigna Healthcare - Remote/Alabama

cigna; Alabama; Hybrid; USD 85,000 - 125,000; Full time

Job summary

Cigna Healthcare is seeking a Provider Contracting Advisor who will operate within Alabama to manage complex contract negotiations for local hospital systems, ancillaries, and physician groups.

You will build provider partnerships, coordinate with Claims Operations, Medical Management, Credentialing, Legal, and Sales, and drive cost and quality initiatives to support the regional strategy.

Qualifications

• 3+ years Managed Care contracting and negotiating experience involving complex delivery systems and organizations.
• Experience developing and managing key provider relationships.
• Knowledge of complex reimbursement methodologies, including incentive-based models.
• Demonstrated ability to build and nurture external provider relationships.
• Understanding of hospital, managed care, and provider business models.
• Team player with ability to operate in a fast-paced, matrix organization.
• Strong written and verbal communication with presentation experience.
• Customer-centric and interpersonal approaches.
• Comfort navigating change and solving problems with contract language and financial acumen.
• Proficiency with Microsoft Office tools.

Responsibilities

• Manages complex contracting and negotiations for fee for service and value-based reimbursements.
• Builds relationships that nurture provider partnerships and seeks value-based opportunities in the local market.
• Initiates and maintains channels of communication with Claims Operations, Medical Management, Credentialing, Legal, and more.
• Contributes to network analytics and alternative network initiatives.
• Works to meet unit cost targets while preserving an adequate network.
• Creates and manages initiatives to improve total medical cost and quality.
• Guides external provider partners on total medical cost initiatives.
• Prepares and analyzes financial impact of larger or complex contracts.
• Ensures accurate contract loading and interface with matrix partners.
• May provide guidance to less experienced specialists.

Skills

Communication skills

Interpersonal skills

Team player

Negotiation skills

Problem solving

Education

Bachelor's degree

MBA or MHA

Tools

Microsoft Office

Job description

WORK LOCATION: will need to live within the defined territory: Alabama

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 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.

POSITION 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.

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

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 need a reasonable accommodation to complete the online application process, please email [e-mail] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.