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.