Provider Account Executive (Kansas City, MO area)

Blue Cross and Blue Shield of Kansas City; Missouri; On-site; USD 85,000 - 120,000; Full time

Benefits offered by this job

401(k)

Paid time off

Tuition reimbursement

Parental leave

Volunteer time off

Employee discount

Professional development

Job summary

Blue Cross and Blue Shield of Kansas City seeks a Provider Account Executive to coordinate and integrate with provider partners as the quarterback of BlueKC Partnership Teams. The role focuses on provider analytics, payments, demographics, contracting and medical management, with work centered in the Kansas City metro area.

You will build durable physician/hospital relationships, drive quality care, cost containment and issue resolution while collaborating with internal teams to address provider

Qualifications

• Bachelor’s degree in Business, Health Care or related field required.
• 5 years of provider relations experience with proven success.
• 5 years of experience with claims coding, ICD and CPT.
• 5 years of experience with health insurance plans, preferred Provider Relations.
• Strong verbal and written communication and presentation skills.
• Proficient in Microsoft Office.

Responsibilities

• Build and maintain positive physician/hospital relationships with focus on quality care, network development and stability.
• Facilitate resolution of escalated or urgent provider issues.
• Liaise with providers on contracting issues; ensure compensation consistency.
• Partner with SMEs to share provider comments and concerns.
• Deliver provider education on directives, policies, programs and business needs.
• Lead in-person provider visits; create agenda, capture actions and follow up.
• Collaborate with internal partners to deliver provider value-added solutions.
• Identify trends/outliers, determine root causes, summarize clearly.
• Present performance data to providers and discuss improvement opportunities.

Skills

Communication

Presentation

Collaboration

Time management

Education

Bachelor’s degree in Business, Health Care or related field

Tools

Microsoft Office

Claims systems

Job description

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contributeAnnual incentive bonus plan based on company achievement of goalsTime away from work including paid holidays, paid time off and volunteer time offProfessional development courses, mentorship opportunities, and tuition reimbursement programPaid parental leave and adoption leave with adoption financial assistanceEmployee discount programJob Description Summary: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.Job DescriptionBuild 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 successFacilitate resolution of escalated or urgent provider issues that are unable to be resolved through standard processes or proceduresServes as a liaison to providers regarding contracting issues; ensures consistency with compensation and paymentPartner with appropriate subject matter experts to share provider’s comments and concernsDevelop and deliver provider education regarding BlueKC directives, mandates, medical and payment policies, programs, and business needsLead 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 providersPresent performance data to providers or provider organization management and discuss opportunities to improve performance.Minimum QualificationsBachelor’s degree in Business, Health Care or related field or an equivalent combination of education and experience5 years of provider relations experience with demonstrated success in developing and maintaining excellent provider relations with all types of providers5 years of experience working with and general understanding of claims coding, medical terminology, ICD and CPT coding systems5 years of experience with health insurance plan, preferred Provider Relations, Marketing/Account Management experienceStrong verbal and written communication skillsStrong presentation skillsProficient in Microsoft (Word, Excel and PowerPoint)Experience with Benefit Designs, Product Offerings, Contracting and Payment StrategyBlue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.