Medicare Provider Contracting Advisor, New York & New Jersey - Cigna Healthcare - Remote

About the position The Medicare Provider Contracting Advisor plays a crucial role within the Provider Contracting Team at Cigna Healthcare, focusing on the strategic direction and management of contracting and network management activities in New York and New Jersey. This remote position involves complex negotiations with healthcare providers, building partnerships, and contributing to network initiatives to enhance value-based care and improve overall healthcare costs and quality.

Responsibilities

• Manages complex contracting and negotiations for fee-for-service and value-based reimbursements with hospitals and other providers. ,
• Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities. ,
• Initiates and maintains effective communication with matrix partners including Claims Operations, 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 and supports network analytics for network solutions. ,
• Works to meet unit cost targets while preserving an adequate network to 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. ,
• Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms. ,
• Creates agreements that meet internal operational standards and external provider expectations, ensuring accurate implementation and administration. ,
• Assists in resolving elevated and complex provider service complaints and negotiates with internal/external partners to resolve issues. ,
• Manages key provider relationships and is accountable for critical interface with providers and business staff. ,
• Demonstrates knowledge of providers in the assigned geographic area and understands 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.

Requirements

• Bachelor's Degree in Finance, Economics, Healthcare, or Business related field; significant industry experience may be considered in lieu of a degree; MBA or MHA preferred. ,
• 3+ years of Healthcare Provider Contracting and Negotiating experience involving complex delivery systems and organizations required. ,
• Experience in developing and managing key provider relationships. ,
• Knowledge of complex reimbursement methodologies, including incentive-based models strongly preferred. ,
• Demonstrated experience in building and nurturing strong external relationships with provider partners. ,
• Intimate understanding and experience with hospital, managed care, and provider business models. ,
• Proven ability to develop strong working relationships within a fast-paced, matrix organization. ,
• Strong written and verbal communication skills with experience in formal presentations. ,
• Customer-centric and interpersonal skills are required. ,
• Demonstrates managerial courage and ability to maneuver effectively in a changing environment. ,
• Superior problem-solving, decision-making, negotiating skills, contract language, and financial acumen. ,
• Proficient with Microsoft Office (Word, Excel, PowerPoint, Outlook). Nice-to-haves Benefits
• Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs. ,
• 401(k) with company match. ,
• Company paid life insurance. ,
• Tuition reimbursement. ,
• Minimum of 18 days of paid time off per year and paid holidays. Apply Job!

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