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    Provider Contract Negotiator – OH or PA

    Some responsibilities include:

    This position serves as an integral member of the Provider Contracting Team. This resource will report directly to the Contracting Lead/Manager 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 providers (e.g. physicians, ancillary facilities)-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.

    -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.

    -Researches and reconciles based on HCP requests (received directly and indirectly)

    -Maintains databases that support specific contract terms/needs (such as P4P, etc)

    -In-house point of contact for contracting calls (responds and distributes as necessary)

    -Receives/responds/distributes incoming mail

    -Maintains departmental contract files

    -Maintains departmental supplies/needs

    -Manages, researches and responds to letters of interest and changes from providers. Directs nonstandard, more complex requests to contracting lead.

    -Maintains and coordinates with matrix partners on recruitments and fee schedule grids.

    -Manages Regional Lead Travel, Expenses and Scheduling as needed

    -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.

    Qualifications

    -Bachelor’s degree preferred
    -Two to three years contracting and negotiating experience involving complex delivery systems and organizations.
    -Strong analytical skills
    -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.

    To find out more visit Indeed.com and search for the position title and company. Apply now. Jobs go fast!

    Posted by vwah012015 @ 1:06 am

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