This position serves as an integral member of the Provider Contracting Team and reports to the Provider Contracting Senior Manager. 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.
- Manages strategic positioning for provider contracting, develops networks and identifies opportunities for greater value-orientation and risk arrangements.
- 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 for Cigna's Commercial, Exchange, and Medicare Advantage products.
- 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 "HCP" 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.
- Should possess a bachelor degree; preferably in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a Bachelor degree. MBA or MHA preferred.
- Three to five years contracting and negotiating experience involving complex delivery systems and organizations required.
- 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 managerial courage as well as 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.