Provider Contracting Advisor

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🕒 Agosto 28

🏈 Alabama – Remoto

🏈 Alabama – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

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The Cigna Group

SiteLinkedInTodas as Vagas

10.000+ funcionários

🏥 Saúde

🛡️ Seguros

Healthcare • Insurance

O Grupo Cigna é uma empresa global de serviços de saúde que oferece produtos e benefícios de seguro médico, odontológico, farmacêutico, comportamental e suplementar para indivíduos, famílias, empregadores, corretores, prestadores de serviços e beneficiários do Medicare. Oferece planos de grupo patrocinados por empregadores, planos individuais e familiares (incluindo ofertas de Inscrição Aberta), Medicare, seguro de saúde internacional cobrindo mais de 200 países, e serviços digitais para membros através da plataforma myCigna (incluindo telemedicina e gestão de sinistros). Seus produtos são disponibilizados por meio de subsidiárias operacionais como a Cigna Health and Life Insurance Company e outras afiliadas regionais.

Descrição

• Manage complex contracting and negotiations for fee-for-service and value-based reimbursements involving hospital systems, ancillary providers, and physician groups • Build provider partnerships and identify broader value-based business opportunities supporting the local market strategy • Maintain communication with matrix partners including Claims Operations, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing, and Service • Contribute to alternative network initiatives and support development of network analytics for network solutions • Meet unit cost targets while preserving an adequate network and maintaining Cigna's competitive position • Create and manage initiatives improving total medical cost and quality • Assess clinical informatics and provide consultative expertise to external provider partners on total medical cost initiatives • Prepare, analyze, review, and project the financial impact of complex provider contracts and alternative contract terms • Create healthcare provider agreements, ensure accurate implementation and administration through matrix partners • Resolve elevated and complex provider service complaints and escalated issues through research and negotiation • Manage key provider relationships and critical interfaces with providers and business staff • Demonstrate knowledge of providers and the competitive landscape in the assigned geographic area • Ensure accurate and timely contract loading and submissions and coordinate network implementation and maintenance • Provide guidance or expertise to less experienced specialists

🎯 Requisitos

• Bachelor's Degree preferred, preferably in Finance, Economics, Healthcare, or Business; industry experience will be considered in lieu of a bachelor's degree • MBA or MHA preferred • 3+ years of managed care contracting and negotiating experience involving complex delivery systems and organizations strongly preferred • Experience developing and managing key provider relationships • Knowledge of complex reimbursement methodologies, including incentive-based models, strongly preferred • Experience building and nurturing strong external relationships with provider partners • Intimate understanding and experience with hospital, managed care, and provider business models • Ability to develop strong working relationships within a fast-paced, matrix organization • Strong written and verbal communication skills, including the ability to influence sales and provider audiences • Experience with formal presentations • Customer-centric and interpersonal skills • Ability to maneuver effectively in a changing environment • Superior problem-solving, decision-making, negotiating, contract-language, and financial-acumen skills • Knowledge and use of Microsoft Office tools • If working from home, cable broadband or fiber optic internet service with at least 10 Mbps download and 5 Mbps upload • Must live within the defined territory of Alabama

🏖️ Benefícios

• Tobacco-free policy • Reasonable accommodation support for the online application process • Remote/home working option, subject to living within Alabama and specified internet requirements