Job Description

Provider Contracting Lead Analyst

The Provider Contracting Lead Analyst serves as an integral member of the Provider Contracting Team and reports to the Contracting Manager or Market Lead. This role assists and supports the day to day contracting and network activities.

Duties and Responsibilities

• Manages submission process of contracting and negotiations for fee for service with physicians, ancillaries and hospitals.
• Supports the development and management of value-based relationships.
• Builds and maintains relationships that nurture provider partnerships 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.
• Supports strategic positioning for provider contracting, assists in the development of networks and helps identify opportunities for greater value-orientation.
• Contributes to the development of alternative network initiatives. Supports 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.
• Supports initiatives that improve total medical cost and quality.
• Drives change with external provider partners by offering consultative expertise to assist with total medical cost initiatives.
• Prepares, analyzes, reviews, and projects financial impact of 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 provider service complaints. Researches problems and negotiates with internal/external partners/customers to resolve escalated issues.
• Manages 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.
• Other duties, as assigned.

Position Requirements

• Bachelor's degree; will consider significant industry experience in lieu of a Bachelor degree.
• 1+ years of Provider Contracting and Negotiating for Healthcare Hospital/Provider/Ancillary group experience required.
• 1+ years Provider Servicing experience
• Experience in developing and managing relationships
• Understanding and experience with hospital, managed care, and provider business models a plus
• Team player with proven ability to develop strong working relationships within a fast-paced, matrix organization.
• The ability to influence audiences through strong written and verbal communication skills. Experience with formal presentations.
• Customer centric and interpersonal skills are required.
• Demonstrates an ability to maneuver effectively in a changing environment.
• Demonstrates problem solving, decision-making, negotiating skills, contract language and financial acumen.
• Proficient with Microsoft Office tools required.

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