Value Performance Principal

BCBSM-posted 8 months ago
$100,000 - $170,000/Yr
Full-time
River Park, FL
Insurance Carriers and Related Activities
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Blue Cross and Blue Shield of Minnesota is hiring a Value Performance Principal in Eagan, MN. The Value Performance Principal is accountable for all activities associated with implementing, monitoring and maintaining external relationships with assigned ACA, Medicaid and Medicare Risk Adjustment & Medicare Star delivery solution vendors. You will focus on developing Key Performance Indicators (KPIs) monitoring vendor performance, reporting progress to Risk Adjustment and Star rating goals, and identifying risks to meeting goals. The Principal is responsible for working with multiple business units to establish and monitor vendors' quantitative and qualitative measure performance against Service Level Agreements (SLA). You will work to facilitate regular business reviews with assigned vendors to discuss their performance, SLAs, deliverables, contract expectations, risks, improvement plans, and future strategic plans. You will oversee vendor processes and workflows, supporting strategy execution, and analyzing performance data.

  • Works closely with the business partners to ensure cost benefit analyses (CBA), SLAs, deliverables, compliance requirements and expectations are incorporated into vendor contracts to facilitate the ability to monitor and manage vendor performance.
  • Develops and maintains effective relationships with business partners to provide support necessary for on-going management and oversight of the vendor portfolio.
  • Works with the business partners and vendors to ensure both parties understand their contractual requirements for any engagement.
  • Participates in developing strategies for risk adjustment, Quality Rating and Medicare Star performance excellence.
  • Communicates with assigned vendors to ensure they are properly educated on Blue Cross expectations throughout the lifecycle of the relationship.
  • Oversee vendor processes to ensure efficiency and alignment with organizational goals.
  • Query and analyze large healthcare datasets using SQL, including data provided by third-party vendors.
  • Visualize data using MS Excel and PowerBI, integrating vendor performance metrics.
  • Conduct financial analysis and develop projections for intervention programs, incorporating vendor-related costs and benefits, and preparing ROI presentations and KPI dashboards.
  • Create and present PowerPoint presentations to leadership, emphasizing vendor performance and impact by providing detailed reports and insights.
  • Apply and maintain knowledge of current and proposed laws, regulations, and CMS guidance related to risk adjustment, as well as general Medicare Advantage and ACA/Exchange requirements, while regularly reviewing vendor adherence and compliance.
  • 5+ years of related professional experience.
  • Proven experience with risk adjustment, Medicare Advantage, and ACA plans.
  • Experience with quality rating programs, including HEDIS, Medicare Advantage Star programs, ACA Quality Rating System, and Medicaid Quality Rating Systems.
  • Proven experience in developing and reporting KPI dashboards.
  • Proficient in SQL for querying data and analyzing large healthcare datasets.
  • Experience working for a health plan or partnering with health plans.
  • Proficient in MS Excel for data visualization and familiar with PowerBI for reporting and data extraction.
  • Bachelor's degree.
  • Experience managing healthcare vendor relationships.
  • Strong problem-solving skills, conflict resolution, facilitation and consensus building skills.
  • Excellent written and presentation communication skills for diverse audiences.
  • Demonstrated organizational relationship management skills.
  • Ability to manage multiple tasks and projects in a timely manner.
  • Ability to navigate complex political situations and act as a change agent.
  • Proven ability to define, analyze and resolve complex business issues.
  • Demonstrated ability to influence and promote ideas to management, business partners and peers.
  • Medical, dental, and vision insurance
  • Life insurance
  • 401k
  • Paid Time Off (PTO)
  • Volunteer Paid Time Off (VPTO)
  • And more
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