Healthcare Provider Contracting Specialist

4 weeks ago

Chattanooga, Tennessee, United States Cigna Full time
Job Summary

The Director, Provider Contracting serves as an integral member of the Provider Contracting Team supporting East Tennessee. This role assists in developing the strategic direction and management of the day-to-day contracting and network management activities for Chattanooga, Knoxville, and Tri-Cities.

Key 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, including Claims Operations, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing, and Service.
  • Manages strategic positioning for provider contracting, develops networks, and identifies opportunities for greater value-orientation and risk arrangements.
  • Contributes to the development of alternative network initiatives and supports the creation of network analytics required for the network solution.
  • Works to meet unit cost targets while preserving an adequate network to achieve and maintain Cigna's competitive position.
  • Creates and manages initiatives that improve total medical cost and quality.
  • Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives.
  • Prepares, analyzes, reviews, and projects the financial impact of larger or complex provider contracts and alternate contract terms.
  • Creates 'HCP' agreements that meet internal operational standards and external provider expectations, ensuring accurate implementation and administration through matrix partners.
  • Assists in resolving elevated and complex provider service complaints, researching problems and negotiating with internal/external partners/customers to resolve highly complex and/or escalated issues.
  • Manages key provider relationships and is accountable for critical interfaces with providers and business staff.
  • Demonstrates knowledge of providers in an assigned geographic area through understanding the interrelationships and competitive landscape.
  • Responsible for accurate and timely contract loading and submissions, as well as interface with matrix partners for network implementation and maintenance.
  • May provide guidance or expertise to less experienced specialists.

Requirements
  • Should possess a bachelor's degree, preferably in Finance, Economics, Healthcare, or Business-related fields. Significant industry experience will be considered in lieu of a bachelor's degree. An MBA or MHA is preferred.
  • 3+ years of healthcare provider contracting and negotiating experience involving complex delivery systems and organizations is required.
  • Experience in developing and managing key provider relationships is essential.
  • Knowledge of complex reimbursement methodologies, including incentive-based models, is strongly preferred.
  • Demonstrated experience in seeking out, building, and nurturing strong external relationships with provider partners is required.
  • Intimate understanding and experience with hospital, managed care, and provider business models are necessary.
  • A team player with proven ability to develop strong working relationships within a fast-paced, matrix organization is required.
  • The ability to influence both sales and provider audiences through strong written and verbal communication skills, as well as experience with formal presentations, is essential.
  • Customer-centric and interpersonal skills are required.
  • Demonstrates managerial courage as well as the ability to maneuver effectively in a changing environment.
  • Superior problem-solving, decision-making, negotiating skills, contract language, and financial acumen are necessary.
  • Knowledge and use of Microsoft Office tools are required.

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