Alternative Payment Model Specialist

Blue Cross and Blue Shield of Kansas • Topeka, KS

6d • Remote

About The Position

Blue Cross and Blue Shield of Kansas is looking to add to our Medical Economics team and has an opportunity for an Alternative Payment Models Specialist. This position supports the implementation and monitoring of Alternative Payment Model (APM) provider reimbursement programs, including Accountable Care Organizations, Patient-Centered Medical Homes, and the Quality-Based Reimbursement Program. This role requires collaboration with internal teams, external vendors, and contracted providers to ensure successful execution, identify areas for continuous improvement, and address provider questions and concerns. “This position is eligible to work remotely, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.” Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas. Why Join Us? Family Comes First : Total rewards package that promotes the idea of family first for all employees. Professional Growth Opportunities: Advance your career with ongoing training and development programs. Dynamic Work Environment: Collaborate with a team of passionate and driven individuals. Trust: Work for one of the most trusted companies in Kansas Compensation $85,600 - $107,000 Exempt Grade 16 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Requirements

• High school diploma or equivalent required.
• Bachelor's degree in Business, Finance, Healthcare Administration, or related field preferred. In lieu of degree, an additional 3 years of relevant experience required.
• Minimum 3 years of experience working with alternative payment models, provider reimbursement, healthcare quality initiatives, or related experience required.
• Knowledge/Skills/Abilities
• Proficiency in Microsoft Excel required, including working with formulas and datasets.
• Proficiency in Microsoft Word required.
• Proficiency with SQL or other data querying tools a plus.
• Understanding of healthcare services, provider reimbursement, healthcare billing practices, medical terminology, and value-based care concepts.
• Strong analytical and problem-solving skills.
• Ability to interpret and work with healthcare data.
• Effective written and verbal communication skills.
• Attention to detail and accuracy in data handling.
• Ability to manage multiple tasks and meet deadlines.
• Demonstrated ability to take ownership of work and deal with ambiguity.
• Collaborative mindset and willingness to learn new processes.
• Broad understanding of the healthcare industry, including knowledge of third-party reimbursement processes, provider relations, and medical economics.
• Understanding of HIPAA, CMS, and other regulatory standards affecting healthcare reimbursement and value-based contracts.

Nice To Haves

• Experience with data analysis, financial modeling, and/or healthcare reimbursement preferred.

Responsibilities

• Assist in maintaining data structures and reports that support APM programs.
• Provide analytical support for monitoring program performance and payment calculations.
• Respond to provider questions regarding program requirements, performance, and reimbursement.
• Assist with peer review and development of new processes to replace legacy workbooks.
• Support communication and collaboration with internal teams and external providers.
• Develop provider communications for annual incentive updates and program changes.
• Administrative upkeep of program infrastructure and systems.
• Maintain and expand upon process documentation.

Benefits

• Base compensation is only one component of your competitive Total Rewards package
• Incentive pay program (EPIP)
• Health/Vision/Dental insurance
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks paid caregiver leave
• 5% 401(k) plan matching
• Tuition reimbursement
• Health & fitness benefits, discounts and resources

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees