Provider Performance & Analytics Leader — Value-Based Care

bcbst

United States

On-site

USD 95,000 - 125,000

Full time

6 days ago

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Job summary

BCBST BlueCross BlueShield of Tennessee, Inc. is seeking a Sr. Provider Performance Specialist within the Provider Outreach and Innovation team.

You will partner with eastern value-based provider groups to assess performance data, identify improvement opportunities, and drive quality, risk adjustment, and population health outcomes. The ideal candidate will translate analytics into actionable provider strategies, consult on program requirements, and collaborate with stakeholders to implement

Qualifications

Bachelor's degree in health- or business-related discipline or equivalent work experience.
4+ years in healthcare, quality improvement, or provider performance.
Experience with risk adjustment, quality programs (HEDIS, STARS), value-based care models, and incentive programs or MLR drivers.

Responsibilities

Support provider performance strategies across risk adjustment, quality measures, MLR, incentive programs, and value-based care.
Analyze provider and population data to identify gaps, trends, and improvement opportunities; support action plans.
Implement targeted strategies to enhance clinical quality outcomes, patient experience, and financial performance.
Educate and consult providers on quality expectations, program requirements, documentation, coding accuracy, and evidence-based care opportunities.
Align and optimize incentive programs to maximize provider engagement and performance.
Utilize dashboards and tools to support engagement and reporting.
Ensure consistent execution of performance initiatives across provider groups.
Travel as required to support provider initiatives (~60%).