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The Cigna Group · 5 months ago

Healthcare - Provider Contract Negotiator - Richmond/McLean, VA market - Hybrid

Richmond, VA

Full-time, Contract

Hybrid

Entry Level

1+ years exp

The Cigna Group is an advocate for better health through every stage of life, guiding customers through the healthcare system. The Provider Contracting Lead Analyst plays a crucial role in managing provider contracts and negotiations, building relationships, and supporting the local market strategy.

CommercialHealth CareHospitalInsuranceMedical

Responsibilities

Manages submission process of contracting and negotiations for fee for service with physicians, ancillaries and hospitals

Supports the development and management of value-based relationships

Builds and maintains relationships that nurture provider partnerships to support the local market strategy

Initiates and maintains effective channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service

Supports strategic positioning for provider contracting, assists in the development of networks and helps identify opportunities for greater value-orientation

Contributes to the development of alternative network initiatives. Supports 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

Supports initiatives that improve total medical cost and quality

Drives change with external provider partners by offering consultative expertise to assist with total medical cost initiatives

Prepares, analyzes, reviews, and projects financial impact of provider contracts and alternate contract terms

Creates 'HCP' agreements that meet internal operational standards and external provider expectations. Ensures the accurate implementation, and administration through matrix partners

Assists in resolving provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve escalated issues

Manages provider relationships and is accountable for critical interface with providers and business staff

Demonstrates knowledge of providers in an assigned geographic area through understanding the interrelationships as well as the competitive landscape

Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance

Other duties, as assigned

Qualification

Provider ContractingFinancial AcumenNegotiatingRelationship ManagementHealthcare KnowledgeMicrosoft OfficeProblem SolvingCommunication SkillsTeam Player

Required

Bachelor's degree strongly preferred in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a Bachelor degree

1+ years of Provider Contracting and Negotiating for Healthcare Hospital/Provider/Ancillary group experience required

Experience in developing and managing relationships

Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization

The ability to influence audiences through strong written and verbal communication skills. Experience with formal presentations

Customer centric and interpersonal skills are required

Demonstrates an ability to maneuver effectively in a changing environment

Demonstrates problem solving, decision-making, negotiating skills, contract language and financial acumen

Proficient with Microsoft Office tools required