Provider Network Analyst

Blue Cross and Blue Shield of Kansas•Topeka, KS

17h•Hybrid

About The Position

Position is responsible for providing support to Provider Network Solutions by conducting network and system analysis including producing, analyzing, interpreting, and using reports needed to provide validation, trending, gap analysis and filings necessary for the review and adherence of network adequacy and performance requirements. Ensures compliance and supports medical review activities and decisions to ensure business practices align with ICD-10 coding. Analysis performed in this role directly supports network contracting and maintenance initiatives. This position directly allows BCBSKS to monitor, comply, and follow CMS network adequacy standards for provider networks and MS-DRG grouper application and support. Direct interaction with Compliance/Legal and BCBSKS senior management in addition to vendors, and federal government programs. Position requires eligibility to enroll as a contractor for BCBSKS to create and maintain an HPMS and CMS contractor profile through secure government websites. “This position is eligible to work 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.”

Requirements

Strong analytical, organizational, planning, and problem-solving skills
Understand and apply statistical inference
Working knowledge of data languages such as SAS or SQL
Ability to perform detailed research and apply independent evaluation of dependencies and/or relational and sequential data sets to understand and interpret data outcomes
Ability to effectively communicate and interface with employees at all levels, must have proficient understanding of medical terminology/technology
Understanding of balance-based problem and solution outcomes
Demonstrated strengths of advanced presentation skills and analysis-based report writing
Must embrace and demonstrate the company’s core competencies and values of integrity, dependability, service, growth and progress, and courage.
Bachelor's degree in Business Administration, Economics, Health Care, Information Systems, Statistics, or related field is required.
Four (4) or more years of experience in related position is required
Excellent verbal and written communication and human relation skills with the ability to interact and communicate effectively to include report writing and lead stakeholder presentations
Must be able to obtain and maintain certification as CMS contractor within 3 weeks of starting position

Nice To Haves

Knowledge of CMS network measurements, requirements, and reporting preferred
Master’s degree in related field is preferred.
Exposure and knowledge of CMS network adequacy requirements preferred
Current American Academy of Professional Coders (AAPC) credentials as Certified Professional Coder (CPC) preferred

Responsibilities

Responsible for development and oversight of Network Adequacy and Accessibility Analysis (gap analysis)
Collects, interprets and evaluates corporate and BCBSKS network partner data, analyzes, reports provider network accessibility and strength for both internal and external reporting
Coordinates and completes Provider Network Solutions network adequacy filings jointly and as directed by corporate compliance
Supports ongoing monitoring of CMS Network Access Plan, identifying and implementing strategies to address gaps in the provider network
Employ statistical skills and knowledge to anticipate and prepare for adequacy changes correlated to network contracting initiatives providing business and network analysis, recommendations and obstacle aversion opportunities
Assist in development of business practices to align with industry standards through collaboration across BCBSKS business areas to ensure alignment of interpretation and use of CMS standards and code application
Create and maintain display dashboards to openly share network adequacy and contracting partner scorecards, current state status and trends, outliers, and areas of improvement for future state, weighing known regulatory changes and contracting initiatives for a variety of provider network stakeholders
Conducts surveys of providers and community stakeholders to determine adequacy of services, provider experience, and strengths or needs within the provider network
Provide project management support, support quality improvement projects, encourage data integrity.