Provider Contracting Advisor

🔥 0 minutes ago

🏈 Alabama – Remote

🏈 Alabama – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

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