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The Provider Contract Negotiator supports the Florida market and serves as an integral member of the Provider Contracting Team, reporting to the Contracting Manager. This role assists with and supports day-to-day contracting and network activities.
Job Responsibility:
Manages the submission process for contracting and fee-for-service negotiations with physicians and ancillary providers
Supports the development and management of value-based provider relationships
Builds and maintains relationships that strengthen provider partnerships in support of local market strategy
Initiates and maintains effective 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 network development, and helps identify opportunities for greater value orientation
Contributes to the development of alternative network initiatives and supports analytics required for network solutions
Works to meet unit cost targets while preserving an adequate network to achieve and maintain Cigna’s competitive position
Supports initiatives aimed at improving total medical cost and quality
Drives change with external provider partners by offering consultative expertise to support total medical cost initiatives
Prepares, analyzes, reviews, and projects the financial impact of provider contracts and alternative contract terms
Creates HCP agreements that meet internal operational standards and external provider expectations
ensures accurate implementation and administration through matrix partners
Assists in resolving provider service complaints by researching issues and negotiating with internal and external partners to resolve escalated concerns
Manages provider relationships and serves as a critical interface between providers and internal business partners
Demonstrates knowledge of providers within an assigned geographic area, including interrelationships and the competitive landscape
Ensures accurate and timely contract loading and submissions and partners with matrix teams for network implementation and maintenance
Performs other duties as assigned
Requirements:
Ideal candidate will currently reside in Lake Mary, Tampa, Miami-Dade, or Broward areas
Bachelor’s degree strongly preferred in Finance, Economics, Healthcare, or a related business field
significant industry experience may be considered in lieu of a degree
One (1) or more years of provider contracting and negotiation experience with healthcare providers or ancillary groups strongly preferred
One (1) or more years of provider servicing or provider relations experience strongly preferred
Proven experience developing and managing professional relationships
Understanding of managed care and provider business models preferred
Team-oriented with the ability to build strong working relationships in a fast-paced, matrixed environment
Ability to influence diverse audiences through strong written and verbal communication skills