Director, Provider Contracting Specialist

3 weeks ago

Austin, Texas, United States The Cigna Group Full time
Job Title: Director, Provider Contracting

As a key member of the Network Development and Strategy Team, the Director, Provider Contracting will play a crucial role in shaping the strategic direction of the organization. This role is responsible for managing the fee-for-service and value-based contracting and network management activities for multiple local geographies.

Key Responsibilities:
  • Manage hospital system contracting and negotiations for fee-for-service and sophisticated value-based reimbursements with providers for Cigna's Medicare product lines.
  • Point person for complex projects related to contracting strategy in the market.
  • Build relationships with providers to nurture partnerships and identify opportunities for value-based business growth.
  • Develop and maintain effective communication channels with matrix partners, including Claims Operations, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales, and Marketing.
  • Manage strategic positioning for provider contracting, develop networks, and identify opportunities for greater value-orientation and risk arrangements.
  • Contribute to the development of alternative network initiatives and provide direction for network analytics.
  • Work to meet unit cost targets while preserving an adequate and marketable network to achieve and maintain Cigna's competitive position.
  • Create initiatives to improve total medical cost and quality.
  • Drive change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives.
  • Prepare, analyze, review, and project the financial impact of larger or complex provider contracts and alternate contract terms.
  • Create provider agreements that meet internal operational standards and external provider expectations.
  • Assist in resolving elevated and complex provider service complaints.
  • Manage key provider relationships and be accountable for critical interfaces with providers and business staff.
Requirements:
  • Bachelor's degree in Finance, Economics, Healthcare, or Business-related field; MBA or MHA preferred.
  • 5+ years of Medicare experience required.
  • 5+ years of contracting and negotiating experience involving complex delivery systems and organizations required.
  • Experience with value-based contracting a plus.
  • Experience leading and mentoring others.
  • 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.
  • Ability to influence both sales and provider audiences through strong written and verbal communication skills.
  • Customer-centric and interpersonal skills required.
  • Demonstrates managerial courage and 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.

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