Senior Provider Performance Specialist

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🔥 0 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟠 Senior

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BlueCross BlueShield of Tennessee

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1952

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

BlueCross BlueShield of Tennessee is a leading health plan provider in Tennessee, serving 3. 4 million members. The company is committed to creating a workforce where everyone is valued, respected, and part of the team, emphasizing diversity and inclusion. They offer a range of career opportunities, including internships through their BlueBridge program, enabling new professionals to transition from college to work. BlueCross BlueShield of Tennessee also focuses on providing exceptional customer service and community care, striving to make a difference in the healthcare industry. It is an independent licensee of the Blue Cross Blue Shield Association and a qualified health plan issuer in the Health Insurance Marketplace.

📋 Description

• Support provider performance strategies across risk adjustment, quality measures, medical loss ratio, incentive programs, and value-based care. • Analyze provider and population-level data to identify gaps, trends, and opportunities for improvement. • Support provider-specific action plans through data segmentation and targeted gap closure strategies. • Implement targeted strategies to enhance clinical quality outcomes, patient experience, and financial performance. • Educate and consult providers on quality performance expectations, program requirements, documentation practices, coding accuracy, and evidence-based care opportunities. • Resolve complex performance and metric-related issues. • Align and optimize incentive programs to maximize provider engagement and performance. • Incorporate quality-based incentives and value-based reimbursement alignment. • Utilize standardized tools, dashboards, and job aids to support provider engagement and internal team effectiveness. • Support quality performance reporting and tracking. • Ensure consistent execution of performance initiatives across provider groups. • Emphasize quality improvement consistency and best practice adoption. • Collaborate with internal stakeholders on quality improvement programs, regulatory requirements, and value-based initiatives. • Travel as required to support provider performance initiatives.

🎯 Requirements

• Bachelor’s Degree in a Health-Related or Business-Related Discipline or equivalent work experience required. • 4 years of progressive experience in healthcare, quality improvement, or provider performance required. • Demonstrated experience with risk adjustment, Quality programs (HEDIS, STARS, etc.), value-based care models, and incentive programs or MLR drivers. • Advanced healthcare data analysis and performance insight development. • Expertise in risk adjustment, HEDIS/STAR quality programs, and value-based care models. • Strong provider consulting and performance improvement capabilities. • Knowledge of healthcare financial drivers including MLR and incentive structures. • Ability to translate analytics into actionable provider strategies. • Sponsorship is not available for this role.

🏖️ Benefits

• Approximately 25% travel is required, primarily for occasional on-site provider visits. • Travel as required to support provider performance initiatives (approximately 60% of the time).