Provider Contracting Advisor - Cigna Healthcare

WORK LOCATION: will need to live within the defined territory: Maryland, Virginia or DCThe Provider Contracting Advisor serves as an integral member of the Provider Contracting Team and reports to the AVP, Provider Contracting.  This role assists in managing commercial contract negotiations and activities for a local given territory.DUTIES AND RESPONSIBILITIESManages complex contracting and negotiations for fee for service and value-based reimbursements (e.g., Hospital systems, Ancillaries, and physician groups).Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities 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.Contributes to the development of alternative network initiatives. Supports and provides direction to develop network 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.Creates and manages initiatives that improve total medical cost and quality.Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist with total medical cost initiatives.Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms.Creates healthcare provider agreements that meet internal operational standards and external provider expectations. Ensures the accurate implementation, and administration through matrix partners. 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 issues.Manages key 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.May provide guidance or expertise to less experienced specialists.POSITION REQUIREMENTSBachelor's Degree Preferred; preferably in the areas of Finance, Economics, Healthcare or Business related. Industry experience will be considered in lieu of a bachelor’s degree. MBA or MHA preferred.3+ years Managed Care contracting and negotiating experience involving complex delivery systems and organizations strongly preferred.Experience in developing and managing key provider relationshipsKnowledge of complex reimbursement methodologies, including incentive based models strongly preferred.Demonstrated experience in seeking out, bui...