Provider Contracting Advisor

This is a fully remote position, open to applicants in Alabama.

📋 Description

• Oversee intricate contracting and negotiation processes for fee-for-service and value-based reimbursements that involve hospital systems, ancillary services, and physician groups.

• Establish provider partnerships and recognize broader value-based business opportunities that align with the local market strategy.

• Maintain effective communication with matrix partners such as Claims Operations, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing, and Service.

• Contribute to initiatives for alternative networks and directly influence the development of network analytics for network solutions.

• Achieve unit cost objectives while sustaining an adequate network and upholding Cigna's competitive edge.

• Design and manage initiatives aimed at enhancing total medical costs and quality.

• Evaluate clinical informatics and provide consulting expertise to external provider partners.

• Prepare, analyze, assess, and project the financial ramifications of complex provider contracts and alternative contract terms.

• Develop healthcare provider agreements, ensure their accurate execution, and manage them through matrix partners.

• Address elevated and intricate provider service complaints and escalated issues.

• Cultivate key provider relationships and maintain critical connections between providers and business personnel.

• Exhibit knowledge of providers, their interrelationships, and the competitive landscape within the designated geographic area.

• Ensure precise and timely contract loading, submissions, network implementation, and maintenance.

• Provide guidance or expertise to less experienced specialists.

⛳️ Requirements

• Bachelor's Degree Preferred; ideally in Finance, Economics, Healthcare, or Business-related fields; relevant industry experience may substitute for a bachelor’s degree.

• MBA or MHA is preferred.

• A minimum of 3 years of experience in Managed Care contracting and negotiations involving complex delivery systems and organizations is strongly preferred.

• Proven experience in developing and managing key provider relationships.

• Strong knowledge of complex reimbursement methodologies, including incentive-based models, is highly preferred.

• Demonstrated capability in seeking out, building, and nurturing robust external relationships with provider partners.

• Deep understanding and experience with hospital, managed care, and provider business models.

• Ability to foster strong working relationships within a dynamic, matrix organization.

• Excellent written and verbal communication skills with experience in formal presentations.

• Strong customer-centric and interpersonal skills are essential.

• Ability to navigate effectively in a constantly changing environment.

• Exceptional problem-solving, decision-making, negotiation, contract language, and financial acumen.

• Proficiency in Microsoft Office tools.

• Home internet access via cable broadband or fiber optic service with a minimum of 10 Mbps download and 5 Mbps upload speeds.

🏝️ Benefits

• Opportunity for remote work / Alabama Work at Home.

• Tobacco-free workplace policy.

• Reasonable accommodation support during the online application process.