Provider Contracting Advisor

🔥 13 hours 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

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Manage complex contracting and negotiations for fee-for-service and value-based reimbursements involving hospital systems, ancillaries 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 direct 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 • Prepare, analyze, review and project the financial impact of complex provider contracts and alternate contract terms • Create healthcare provider agreements, ensure accurate implementation and administer them through matrix partners • Resolve elevated and complex provider service complaints and escalated issues • Manage key provider relationships and critical interfaces with providers and business staff • Demonstrate knowledge of providers, interrelationships and competitive landscape in the assigned geographic area • Ensure accurate and timely contract loading, submissions, network implementation and maintenance • Provide guidance or expertise to less experienced specialists

🎯 Requirements

• Bachelor's Degree Preferred; preferably in Finance, Economics, Healthcare or Business related; industry experience will be considered in lieu of a bachelor’s degree • MBA or MHA preferred • 3+ years 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 • Demonstrated experience seeking out, 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 and experience with formal presentations • Customer-centric and interpersonal skills required • Ability to maneuver effectively in a changing environment • Superior problem-solving, decision-making, negotiating, contract language and financial acumen • Knowledge and use of Microsoft Office tools • Home internet via cable broadband or fiber optic service with at least 10 Mbps download / 5 Mbps upload

🏖️ Benefits

• Remote work / Alabama Work at Home • Tobacco-free policy • Reasonable accommodation support for the online application process