Job Description

Provider Contracting Advisor

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 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.
• 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.
• Contributes to the development of alternative network initiatives.
• Works to meet unit cost targets, while preserving an adequate network.
• Creates and manages initiatives that improve total medical cost and quality.
• Drives change with external provider partners.
• Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts.
• Creates healthcare provider agreements that meet internal operational standards and external provider expectations.
• Assists in resolving elevated and complex provider service complaints.
• Manages key provider relationships.
• Demonstrates knowledge of providers in an assigned geographic area.
• Responsible for accurate and timely contract loading and submissions.
• May provide guidance or expertise to less experienced specialists.

Position Requirements

• Bachelor's Degree preferred. Industry experience will be considered in lieu of a degree. MBA or MHA preferred.
• 3+ years Managed Care 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.
• 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. For this position, we anticipate offering an annual salary of 92,000 - 153,300 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.

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 seeyourself@thecignagroup.com for assistance. 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.

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