Sr. Provider Performance Specialist

BlueCross BlueShield of Tennessee • Chattanooga, TN

6d • Hybrid

About The Position

We are hiring a Sr. Provider Performance Specialist on our Provider Outreach and Innovation team at BCBST! In this role, you will support primarily eastern value-based provider groups, partnering directly with provider organizations to assess performance data, identify opportunities for improvement, and drive better quality, risk adjustment, and population health outcomes. You'll serve as a trusted advisor to providers, leveraging analytics, relationship management, and strategic problem-solving skills to help practices succeed in value-based arrangements while delivering measurable results for members and the organization. This position offers the opportunity to influence provider performance, strengthen partnerships, and support healthcare transformation through data-driven decision-making. To be successful in this role, in addition to the core job requirements, you'll bring strong analytical capabilities, relationship management skills, customer service expertise, and a proactive approach to problem-solving. The ideal candidate is comfortable interpreting performance data, communicating insights to provider partners, and collaborating with stakeholders to implement strategies that improve outcomes. Note: This role supports primarily eastern value-based provider groups. Approximately 25% travel is required, primarily for occasional on-site provider visits. Sponsorship is not available for this role.

Requirements

• Bachelor’s Degree in a Health-Related or Business-Related Discipline or equivalent work experience required.
• 4 years - Progressive experience in healthcare, quality improvement, or provider performance required.
• Demonstrated experience with risk adjustment, Quality programs (HEDIS, STARS, etc.), value-based care models, and incentive programs or MLR drivers.
• Advanced healthcare data analysis and performance insight development
• Expertise in risk adjustment, HEDIS/STAR quality programs, and value-based care models
• Strong provider consulting and performance improvement capabilities
• Knowledge of healthcare financial drivers including MLR and incentive structures
• Ability to translate analytics into actionable provider strategies

Responsibilities

• Support provider performance strategies across risk adjustment, quality measures, medical loss ratio, incentive programs, and value-based care.
• Analyze provider and population-level data to identify gaps, trends, and opportunities for improvement, and support provider-specific action plans through data segmentation and targeted gap closure strategies.
• Implement targeted strategies to enhance clinical quality outcomes, patient experience, and financial performance.
• Educate and consult providers on quality performance expectations, program requirements, documentation practices, coding accuracy, and evidence-based care opportunities, while resolving complex performance and metric-related issues.
• Align and optimize incentive programs to maximize provider engagement and performance, incorporating quality-based incentives and value-based reimbursement alignment.
• Utilize standardized tools, dashboards, and job aids to support provider engagement and internal team effectiveness, including quality performance reporting and tracking tools.
• Ensure consistent execution of performance initiatives across provider groups, emphasizing quality improvement consistency and best practice adoption.
• Collaborate with internal stakeholders to align strategies supporting quality improvement programs, regulatory requirements, and value-based initiatives.
• Travel as required to support provider performance initiatives (approximately 60% of the time).

What This Job Offers

• Job Type: Full-time
• Career Level: Senior