Please Note: This role is hybrid with the expectation of working 3 days per week onsite and 2 days per week remote.
The Provider Contracting Advisor (PCA) is responsible for the overall management of the Behavioral Outpatient network which consists of identified large, high-volume, multi-state or national practices that provide virtual and digital resources. These regional and/or national outpatient organizations account for a significant portion of the overall spend. Therefore, the PCA role is integral to the organization’s affordability strategy. The PCA is not only responsible for maintaining the contract and re-negotiating rates, but the PCA is also responsible for collaborating with these entities to identify performance improvement and partnership opportunities. The PCA will work with various matrix partners in the behavioral organization as well as other parts of the enterprise to develop and implement specific actions in order to meet unit cost and budget targets and enhance the network’s competitive position in the marketplace.
Responsibilities
Identify partnership and unique contracting opportunities to expand the scope and quality of care offered.
Evaluate and execute new contracts for ancillary providers and identified high volume national practices.
Implementation of new or unique contracting and reimbursement strategies for identified contracts.
Proactively assess and plan affordability opportunities for assigned book of business; opportunities include but are not limited to contract performance management, rate corrections, product segmentation and/or value based contracting opportunities.
Develop and/or execute rate strategies for the large national entities and coordinate with other department contractors when necessary.
Request full models and benchmarking for any scheduled negotiation in order to facilitate the reimbursement strategy planning process.
Facilitate unplanned as well as planned renegotiations and ensuring financial approvals and targets are met and completed within service level targets.
Work with Network Operations to process all rate, service and location changes within service level targets.
Collaborate with Provider Relations to improve service and satisfaction for the outpatient network of ancillary providers and identified high volume national clinics.
Participate in any department and/or enterprise projects and work groups.
Qualifications
Bachelor’s degree or equivalent work experience required; Master’s preferred in health care or related field.
5+ years of experience in behavioral contracting.
Experience working with Value/Measurement based contracting and analysis.
Experience working with Medicare/Medicaid contracting and compliance requirements for both
Understanding of contract language and must be comfortable with high dollar and complex negotiations.
Knowledge of policy/procedures, behavioral operations, and supporting operating systems.
Strong analytical skills with the ability to solve complex problems as well as able to think strategically while understanding how specific decisions impact overall vision/mission.
Excellent oral, written, and presentation skills. Exceptional communication skills to handle complex, national scale negotiations.
Must be highly proficient in Excel and Powerpoint
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
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.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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