Provider Account Executive (Kansas City, MO area)

Blue Cross and Blue Shield of Kansas City•Kansas City, MO

11d•Onsite

About The Position

The Provider Account Executive acts as the central point of coordination and integration with key provider partners on behalf of Blue KC. This role is charged with acting as the “quarterback” for the BlueKC Partnership Teams that encompass all traditional and value-based payer-provider functions and interests (i.e. provider analytics, provider payments, demographic registration/demographics, contracting, medical management including pharmacy and compliance). The candidate/employee for this position must reside in the Kansas City metropolitan area.

Requirements

Bachelor’s degree in Business, Health Care or related field or an equivalent combination of education and experience
5 years of provider relations experience with demonstrated success in developing and maintaining excellent provider relations with all types of providers
5 years of experience working with and general understanding of claims coding, medical terminology, ICD and CPT coding systems
5 years of experience with health insurance plan, preferred Provider Relations, Marketing/Account Management experience
Strong verbal and written communication skills
Strong presentation skills
Proficient in Microsoft (Word, Excel and PowerPoint)
Experience with Benefit Designs, Product Offerings, Contracting and Payment Strategy

Responsibilities

Build and maintain positive physician/hospital relationships with focus on a collaborative approach to quality care, network development and stability, cost containment and identification and resolution of barriers to success
Facilitate resolution of escalated or urgent provider issues that are unable to be resolved through standard processes or procedures
Serves as a liaison to providers regarding contracting issues; ensures consistency with compensation and payment
Partner with appropriate subject matter experts to share provider’s comments and concerns
Develop and deliver provider education regarding BlueKC directives, mandates, medical and payment policies, programs, and business needs
Lead in-person provider visits (create agenda, facilitate meeting, capture action items, send notes and own follow – up to the visits/meetings)
Collaboration with other internal partners, provider value-added consultation and solutions to assigned providers.
Includes trends and outliers in populations, determining root causes to variances and summarize in understandable terms.
Includes presenting at educational conferences, submitting data to newsletters, and provider educational webinars and on-site training to providers
Present performance data to providers or provider organization management and discuss opportunities to improve performance.