Provider Contracting Director

Role Description

Overall accountability for ensuring that field contractors comply with contracting standards, including:

• Use of current core contracts
• Reimbursement standards
• Network and contract policy
• Provider contract escalation and review process

Provide guidance and support to field contractors on national standards and use of the Contract Management System.

Support field contractors on non-standard issues and work closely with the National Contracting Standards & Policy team on:

• Policy
• Language
• Ability to administer issues
• Reporting and compliance with the exception review process

Contract Review and Escalation Process:

• Work with contractor to develop appropriate response and/or contractual language that does not jeopardize Cigna's contracts with employers, internal policies, or standards.
• Any language request which could have adverse impact to Cigna is brought to Contracting Regional Vice President (RVP) for discussion and intervention with the provider, if necessary.
• Ensure required documentation is complete prior to signature by RVP or Market Lead.
• Facilitate internal and external audit requirements.

Training/Contract Standards:

• Ensures members of field contracting team receive appropriate and continuous training in all aspects of contracting standards, including:
• Use of current, appropriate, core contract templates
• Preferred reimbursement standards
• National network and contracting policy
• Standard contract process
• Ensures understanding and compliance by field contractors with the standard contract process and review of all exceptions to:
• Ability to administer
• Financial objectives
• Policies
• Language
• Provides consultative support to field contractors on contracting, policy, and procedural issues as needed.

Contract Management System:

• Supports field contracting in maximizing use of the system.
• Ensure all new employees receive the appropriate training.
• Monitors Contract Manager usage in accordance with the established guidelines.
• Develop contract language and rate exhibit options for field use.

Administration:

• Collaborates with other RDs, Network Analytics Unit, and other national functions such as claim operations, medical management, and legal to share best practices and devise creative solutions to complex problems.
• Works with national groups to continually review and improve the SARU (Satisfactory, Acceptable, Reviewable and Unacceptable) contract standards for all contract types.
• Partners closely with US Medical Network Contracting Readiness to ensure policies and standards are communicated to the field staff appropriately.

Policy:

• Works closely with Standards & Policy Committee to identify and resolve issues requiring cross-functional solutions, policymaking, and communication.
• Provides input and support to national projects (e.g. new product roll-outs, regulatory compliance initiatives, etc.) requiring contract content reviews, language compliance assessments, and/or network participation assessments.
• Works with local contract teams on language remediation initiatives.

Qualifications

• 7+ years in Medical Contracting, Negotiating, and Provider Services
• Ability to foster collaboration, value others' perspectives, and gain support and buy-in for organizational proposals
• Matrix management skills
• Ability to drive and lead an organization through change
• Excellent interpersonal and relationship management skills
• Excellent oral, written, and presentation skills required
• Strong collaboration, negotiation, and leadership skills
• Strong organizational and analytical skills that result in conclusive recommendations
• Ability to think critically with respect to improvement of end-to-end business process

Requirements

• 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.

Benefits

• Annual salary of 156,700 - 261,100 USD / yearly, depending on relevant factors, including experience and geographic location
• Eligible to participate in an annual bonus and long-term incentive plan
• Comprehensive range of benefits, including medical, vision, dental, and well-being and behavioral health programs
• 401(k) plan
• Company paid life insurance
• Tuition reimbursement
• A minimum of 18 days of paid time off per year
• Paid holidays
• Leaves of absence