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.
-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.
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