Strategic Provider Relationship Analyst

🔥 3 minutes ago

🏈 Alabama, Arizona, +23 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote 🚗 Michigan – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $60.9k - $97.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Blue Cross NC

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross NC is a health insurance provider that offers a range of health plans and services to individuals and groups. The company focuses on delivering quality healthcare coverage and improving health outcomes for its members through innovative health programs and services. Blue Cross NC is committed to enhancing access to affordable healthcare while supporting the health and wellness of the communities it serves.

📋 Description

• Develop and execute strategic provider engagement and network initiatives supporting Blue Cross NC Medicare Advantage products • Build and maintain strategic partnerships with professional, institutional, ancillary, and statewide providers • Support provider contracting, relationship management, payment model, and reimbursement methodology initiatives • Conduct financial and quantitative analysis to ensure agreements and reimbursement are implemented accurately • Develop provider education formats, workshops, presentations, and education events • Schedule, plan, and conduct provider and stakeholder visits • Address provider inquiries, concerns, non-compliance issues, and corrective actions • Manage resolution of large-scale and complex high-dollar operational issues • Recommend process improvements to enhance provider relationships and reduce administrative costs • Identify opportunities to control medical expenses and deploy regional or stakeholder-specific action plans • Represent BCBSNC in stakeholder meetings and participate in negotiations as needed • Analyze products and recommend improvements based on technologies, trends, best practices, and service offerings • Partner with stakeholders to understand their processes, procedures, and systems • Track stakeholder issues through root-cause analysis, escalation, documentation, and closure • Ensure compliance with state, federal, and BCBSA regulations

🎯 Requirements

• Bachelor's degree or advanced degree where required • 3+ years of experience in a related field • In lieu of degree, 5+ years of experience in a related field • Proven Medicare Advantage experience or experience in a managed care or health plan environment supporting MA products • Ability to educate and advise providers on Medicare Advantage processes, products, claims, and operational requirements • Provider-facing or customer service experience • Ability to build strong cross-functional relationships • Strong communication skills and ability to explain complex topics and deliver difficult messages professionally • Authorization to work in the United States • Ability to work in one of the employer's approved states

🏖️ Benefits

• Work-life balance, flexibility, and autonomy • Medical, dental, and vision coverage • Health and wellness programs • Parental leave and support • Adoption and surrogacy assistance • Career development programs • Tuition reimbursement for continued education • 401(k) match including an annual company contribution • Annual Incentive Bonus based on annual corporate goal achievement and individual performance • Paid Time Off (PTO) • Reasonable accommodations for applicants with disabilities