Manager – Provider Contracting

Manager – Provider Contracting

Requirements

• Should possess a bachelor degree; preferably in the areas of Finance, Economics, Healthcare or Business related. Significant industry experience will be considered in lieu of a Bachelor degree. MBA or MHA preferred.
• 5+ years of Provider Contracting and Negotiating experience involving complex delivery systems and organizations required
• Experience with Physician, Hospital and Ancillary group contracting and negotiations
• Experience with Healthcare – Commercial/Employer side
• 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.
• The ability to influence both sales and provider audiences through strong written and verbal communication skills. Experience with formal presentations.
• Customer centric and interpersonal skills are required.
• Demonstrates managerial courage as well as an ability to maneuver effectively in a changing environment.
• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.
• Proficient with Microsoft Office (Word, Excel, PowerPoint, Outlook)

Responsibilities

• Manages contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large physician groups).
• 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 but not limited to, 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. Supports and provides direction to develop 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 financial impact of larger or complex 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 elevated and complex provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.
• Manages key 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.
• May provide guidance or expertise to less experienced specialists.

Preferred Qualifications

• Knowledge of complex reimbursement methodologies, including incentive based models strongly preferred.
• MBA or MHA preferred.