Provider Contracting Lead Analyst
The Cigna Group
full-time
Posted on:
Location Type: Hybrid
Location: Richmond • Virginia • United States
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Job Level
About the role
- Manages submission process of contracting and negotiations for fee for service with physicians, ancillaries and hospitals
- Supports the development and management of value-based relationships
- Builds and maintains relationships that nurture provider partnerships 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
- Supports strategic positioning for provider contracting, assists in the development of networks and helps identify opportunities for greater value-orientation
- Contributes to the development of alternative network initiatives
- Supports 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
- Supports initiatives that improve total medical cost and quality
- Drives change with external provider partners by offering consultative expertise to assist with total medical cost initiatives
- Prepares, analyzes, reviews, and projects financial impact of 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 provider service complaints
- Researches problems and negotiates with internal/external partners/customers to resolve escalated issues
- Manages 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
Requirements
- Bachelor's degree strongly preferred in the areas of Finance, Economics, Healthcare or Business related
- Significant industry experience will be considered in lieu of a Bachelor degree
- 1+ years of Provider Contracting and Negotiating for Healthcare Hospital/Provider/Ancillary group experience required
- 1+ years prior Provider Servicing/Provider Relations experience strongly preferred
- Experience in developing and managing relationships
- Understanding and experience with hospital, managed care, and provider business models a plus
- Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization
- The ability to influence 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
- Demonstrates problem solving, decision-making, negotiating skills, contract language and financial acumen
- Proficient with Microsoft Office tools required
Benefits
- Health insurance
- 401(k) matching
- Flexible work arrangements
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
Provider ContractingNegotiatingFinancial AnalysisContract ManagementValue-Based RelationshipsNetwork DevelopmentAnalyticsProblem SolvingDecision-MakingContract Language
Soft skills
Interpersonal SkillsCommunication SkillsTeam PlayerRelationship ManagementCustomer CentricInfluencing SkillsAdaptabilityConsultative ExpertiseNegotiating SkillsPresentation Skills