Provider Contracting Advisor

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

📋 Description

• Oversee intricate contracting and negotiation processes for both fee-for-service and value-based reimbursements involving hospital systems, ancillary providers, and physician groups.

• Foster provider collaborations and pinpoint wider value-based business prospects that align with the local market strategy.

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

• Contribute to initiatives related to alternative networks and assist in the development of network analytics for network solutions.

• Achieve unit cost objectives while ensuring a robust network and maintaining Cigna's competitive edge.

• Design and oversee initiatives aimed at improving total medical expenses and quality.

• Evaluate clinical informatics and offer consultative support to external provider partners regarding total medical cost initiatives.

• Prepare, analyze, review, and forecast the financial implications of intricate provider contracts and alternative contracting terms.

• Draft healthcare provider agreements, ensuring accurate execution and administration through matrix partners.

• Address elevated and complex provider service complaints and escalated issues through thorough research and negotiation.

• Manage significant provider relationships and essential interactions with providers and business staff.

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

• Ensure timely and precise contract loading and submissions while coordinating network implementation and upkeep.

• Provide mentorship or expertise to less experienced specialists.

⛳️ Requirements

• Bachelor's Degree is preferred, ideally in Finance, Economics, Healthcare, or Business; relevant industry experience may substitute for a 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, particularly incentive-based models, is strongly preferred.

• Demonstrated experience in establishing and nurturing robust external relationships with provider partners.

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

• Capacity to cultivate strong working relationships within a dynamic, matrixed organization.

• Excellent written and verbal communication abilities, including the capacity to influence sales and provider audiences.

• Experience delivering formal presentations.

• Strong customer-focused and interpersonal skills.

• Ability to navigate effectively in a changing environment.

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

• Proficient in Microsoft Office tools.

• If working remotely, must have cable broadband or fiber optic internet service with a minimum of 10 Mbps download and 5 Mbps upload speed.

• Must reside within the defined territory of Alabama.

🏝️ Benefits

• Tobacco-free policy.

• Support for reasonable accommodation during the online application process.

• Option for remote/home working, contingent on residing in Alabama and meeting specified internet requirements.