Provider Contracting Lead Analyst - Virginia market - The Cigna Group
McLean, VA
About the Job
WORK LOCATION: supports our Virginia market - Preferred candidate to live in either Richmond or McLean, VA area
Hybrid position - will need to work in the office or visit Providers 3 days per week
The Provider Contracting Lead Analyst serves as an integral member of the Provider Contracting Team and reports to the Contracting Manager or Market Lead. This role assists and supports the day to day contracting and network activities.
DUTIES AND 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
POSITION REQUIREMENTS
+ 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
+ 1+ years prior Provider Servicing/Provider Relations experience strongly preferred
+ Experience in developing and managing relationships
+ Understanding and experience with hospital, managed care, and provider business models a plus
+ 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.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._
Hybrid position - will need to work in the office or visit Providers 3 days per week
The Provider Contracting Lead Analyst serves as an integral member of the Provider Contracting Team and reports to the Contracting Manager or Market Lead. This role assists and supports the day to day contracting and network activities.
DUTIES AND 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
POSITION REQUIREMENTS
+ 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
+ 1+ years prior Provider Servicing/Provider Relations experience strongly preferred
+ Experience in developing and managing relationships
+ Understanding and experience with hospital, managed care, and provider business models a plus
+ 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.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
_Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._
_If you require reasonable accommodation in completing the online application process, please email:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._
_The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._
_Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._
Source : The Cigna Group
