Provider Contracting Sr Specialist
Cigna - Blue Bell, PA

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Job Description

This position serves as an integral member of the Provider Contracting Team. This resource will report directly to the Contracting Lead and will assist in developing the strategic direction and management of the day to day contracting activities for a given territory.

DUTIES AND RESPONSIBILITIES
  • Manages contracting with hospitals and other providers (e.g., Hospitals, Ancillaries, and large physician groups).
  • Specific responsibilities include, but are not limited to: strategic positioning for contracting with providers and developing networks in outlying areas
  • Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms.
  • Conducts negotiations and drafts individual and group contracts.
  • Ensures the smooth operation and administration of provider agreements.
  • Track financial performance of contracts and ensure compliance with contracting guidelines.
  • May provide guidance or expertise to less experienced specialists.
  • 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 and sensitive issues.
  • Other projects and duties as assigned.
  • Responds to provider inquiries, concerns, complaints, appeals and grievances.
  • Initiates and maintains effective channels of communication with providers and related office staff.
  • Demonstrates knowledge of Providers in assigned geographic area. Understands interrelationships among providers in local market.
  • Respond to provider inquiries and instructions regarding provider data in CIGNA systems.
  • Coordinate these provider interactions with Provider Relations Representatives and Matrix Partners as necessary.
  • Communicate provider demographic and reimbursement information to PDM for loading into CIGNA systems.
  • Initiates and maintains effective channels of communication with matrix partners, particularly with provider services staff in the field.
POSITION REQUIREMENTS
  • Bachelor's degree, MBA or MHA preferred.
  • Three to five years contracting and negotiating experience involving complex delivery systems and organizations.
  • Strong analytical skills
  • Intimate knowledge of hospital and managed care finance.
  • Strong written and verbal communication skills and experience with formal presentations.
  • Superior problem solving, decision-making and negotiating skills.
  • Ability to use PC software and multiple CIGNA systems
  • Team player with proven ability to develop strong working relationships within a matrix organization.
  • Technical/Functional expertise: Provider Contracting, Negotiation, Strategic planning
  • Ability to manage in a production and matrix environment.

CIGNA - 2 years ago - save job
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With a significant position in the US health insurance market, CIGNA covers some 11.5 million Americans with its various medical plans. The...