Transplant Provider Contracting Advisor - Work from home at Cigna in Bloomfield, Connecticut

Posted in Health Care 16 days ago.

Type: Full-Time





Job Description:

SUMMARY

This position serves as an integral member of the Provider Contracting Team for the Cigna LifeSource Transplant Network®. This resource will report directly to the Provider Contracting Senior Manager and will assist in developing the strategic direction and management of the day to day contracting activities across the nation for transplant services and Chimeric Antigen Receptor T Cell Therapy (CAR-T Therapy.)

DUTIES AND RESPONSIBILITIES

• Manage complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, ancillary services, and large physician groups).

• Build 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.

• Manages strategic positioning for provider contracting, develop networks and identify opportunities for greater value-orientation and risk arrangements.

• 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.

• Prepares, analyzes, reviews, and projects financial impact of complex provider contracts and alternate contract terms.

• Create agreements and amendments 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.

• Responsible for developing global case rates for the transplantation and CAR-T Therapy, which includes Hospital, Physicians,

ancillary services, labs, rehabilitation services, organ procurement including transportation and bone marrow registry charges.

• Vast level of knowledge regarding specialty services to ensure cost competiveness.

• Collaborate with commercial contracting teams and understand interrelationships among peers in the commercial market.

• Collaborate with the commercial Cigna contracting leads throughout your discussions with the hospital. Work in

conjunction with Regional Directors and Regional Vice Presidents.

• Ability to work independently with internal matrix partners and external providers to identify complex issues and find the

correct or most effective solution. This is an essential part of the ongoing operations of the Cigna LifeSource Transplant

Network.

• Provide expert content/professional leadership on complex provider contracting assignments and projects. Manage

contracting with hospitals and physicians. Specific responsibilities include, but are not limited to: strategic positioning for

contracting with providers, overseeing the functions for negotiating contracts with physicians, hospitals, and other ancillary

services to provide services. Tracks and monitors financial performance of contracts. Ensure compliance with contracting

guidelines. Exercise considerable creativity, foresight, and judgment in conceiving, planning, and delivering initiatives.

• Uses deep professional knowledge and acumen to advise functional leaders. Focuses on providing thought leadership

within provider contracting, however, works on broader projects and duties as assigned, which require understanding of

wider business.

• Attend Regional Vice President event planning meetings and routinely present complex contracting arrangements and

financial details to RVP, Medical Directors, Senior Directors and Market Presidents. Role requires strategic

communications with the commercial medical contracting team and sales partners throughout the enterprise.

• Participate in strategic planning sessions with leadership to manage the current network and review new opportunities.

• Implementation of best practices for Transplant Services and Chimeric Antigen Receptor T Cell Therapy (CAR-T Therapy)

contracting.

• Interpret internal or external issues and recommend solutions/best practices. Solve complex problems; taking a broad

perspective to identify solutions.

• Provides counsel and advice to management on significant provider contracting matters, often requiring coordination

between organizations.

• Interprets internal or external issues and recommends solutions/best practices. Solves complex problems; takes a broad

perspective to identify solutions.

• Leads the planning and implementation of negotiations, and regularly interfaces with senior management

QUALIFICATIONS

• Bachelor degree preferred. Three to five years of contracting and negotiating experience involving complex

delivery systems and organizations is required. Area of focus in Finance, Economics, Healthcare or Business

related strongly preferred.

• Technical/Functional expertise: Provider Contracting, Negotiation, Strategic planning.

• Experience in developing and managing key provider relationships.

• Knowledge of complex reimbursement methodologies.

• Demonstrated experience in seeking out, building and nurturing strong external relationships with provider partners.

• Intimate understanding and experience with hospital, managed care, and provider business models.

• Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization.

• The ability to influence provider audiences through strong written and verbal communication skills.

• Experience with formal presentations beneficial.

• Customer centric and interpersonal skills are required. Adapts nicely to the audience at hand.

• Demonstrates managerial courage as well as an ability to maneuver effectively in a changing environment.

• Superior problem solving, decision-making, negotiating skills, contract language and financial acumen.

• Knowledge and use of Microsoft Office tools.

• Strong analytical skills.

• Detail oriented.

• Exceptional customer service skills.

• Superior problem solving decision-making and negotiating skill sets.

• Ability to manage in a production matrix environment.

• Strong written and verbal communication skills.

• Team player with proven ability to develop strong working relationships with matrix partners.

• Be courageous in looking at new alternatives, think outside the box.

This position is not eligible to be performed in Colorado.

About Cigna

Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. We offer an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. Together, with our 74,000 employees worldwide, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation.

When you work with Cigna, you'll enjoy meaningful career experiences that enrich people's lives while working together to make the world a healthier place. What difference will you make? To see our culture in action, search #TeamCigna on Instagram.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.