BlueAdvantage Network Provider Consultant

Blue Cross & Blue Shield of Mississippi • Flowood, MS

2d

About The Position

The BlueAdvantage Network Provider Consultant serves as a consultant and corporate liaison to BlueAdvantage Network Providers, including, but not limited to professional, facility, and allied providers. This role provides consultative services to the BlueAdvantage Network Provider community to ensure compliance with BlueAdvantage contracts and performance expectations. This includes sharing of Network Provider performance against BlueAdvantage requirements, Centers of Medicare and Medicaid Services (CMS) rules for STARS ratings and clinical improvement of patients to include HEDIS improvement and gaps in care closure. The BlueAdvantage Network Provider Consultant will also be responsible for ensuring Network Provider compliance to improve administrative and clinical efficiency/effectiveness to assist in providing the highest quality and most cost effective healthcare to BlueAdvantage Members.

Requirements

• A Bachelor’s degree in Business Administration, Health Administration, or Nursing.
• At least three (3) years of professional healthcare experience and must possess knowledge of member and provider contract benefits, clinical guidelines, medical policy and claims processing for designated line(s) of business, or possess equivalent healthcare related industry knowledge.
• Medicare Advantage benefit plans experience.
• Experience in working with healthcare providers on improvement in Healthcare Effectiveness Data and Information Set (HEDIS) performance measures.
• Experience with and knowledge of Medicare STARS program to measure health plan and healthcare provider performance.
• Knowledge of the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) risk adjustment model.
• Exhibits professional and positive demeanor with excellent communication.
• Excellent verbal and written communication skills including exemplary presentation skills, development of correspondence, review and management of performance documents etc.
• Ability to travel throughout the state to meet with BlueAdvantage Network Providers.
• Demonstrated proficiency in Microsoft Office Suite, especially Excel, Word and PowerPoint.

Responsibilities

• Serve as a consultant and corporate liaison to BlueAdvantage Network Providers.
• Provide consultative services to the BlueAdvantage Network Provider community to ensure compliance with BlueAdvantage contracts and performance expectations.
• Share Network Provider performance against BlueAdvantage requirements, Centers of Medicare and Medicaid Services (CMS) rules for STARS ratings and clinical improvement of patients to include HEDIS improvement and gaps in care closure.
• Ensure Network Provider compliance to improve administrative and clinical efficiency/effectiveness to assist in providing the highest quality and most cost effective healthcare to BlueAdvantage Members.

Benefits

• comprehensive benefits package that is worth approximately one-third of the salary compensation
• benefits program is among the best in the health care field

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees