Provider Contracting Lead Analyst

Provider Contracting Lead Analyst

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’s degree.
• 1+ years of Provider Contracting and Negotiating for Healthcare 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 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.

Responsibilities

• Manages submission process of contracting and negotiations for fee for service with physicians and ancillaries.
• 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. Research 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.

Preferred Qualifications

• 1+ years prior Provider Servicing/Provider Relations experience strongly preferred
• Understanding and experience with managed care, and provider business models a plus