Provider Contracting Lead Analyst - Cigna Healthcare - Morristown, NJ

This position serves as an integral member of the Provider Contracting Team and reports to the AVP of Contracting.

This role assists in developing the strategic direction and managing day-to-day contracting and network management activities for a specific territory within New Jersey.

DUTIES AND RESPONSIBILITIES


* Manages complex contracting and negotiations for fee-for-service and value-based reimbursements with hospitals and other providers (e.g., Hospital systems, Ancillaries, and large 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 and Medical Management.

Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing, and Service.


* Manages strategic positioning for provider contracting, develops networks, and identifies 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.


* 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 the financial impact of larger or complex provider contracts and alternate contract terms.


* Creates "HCP" 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 REQUIREMENTS


* Should possess a bachelor's degree; preferably in the areas of Finance, Economics, Healthcare, or Business-related.

Significant industry experience will be considered in lieu of a Bachelor's degree.

MBA or MHA preferred.


* 3+ years of contracting and negotiating experience involvi...