Senior Value-Based Provider Performance Advisor

BlueCross BlueShield of Tennessee, Inc.; Chattanooga (TN); On-site; USD 90,000 - 130,000; Full time

Job summary

BlueCross BlueShield of Tennessee, Inc. is seeking a Sr. Provider Performance Specialist to support eastern value-based provider groups, using analytics to drive quality, risk adjustment and population health improvements.

You’ll advise providers and collaborate with stakeholders to implement data-driven strategies that improve outcomes while managing incentive programs. The role requires strong analytical and relationship-management skills, experience with HEDIS/STAR programs, and the ability

Qualifications

• Bachelor’s degree in a health-related or business-related discipline or equivalent work experience.
• 4 years progressive healthcare quality or provider performance experience.
• Experience with risk adjustment and quality programs (HEDIS, STAR) and value-based care.
• Strong analytics, provider consulting and problem-solving abilities.
• Ability to translate analytics into actionable provider strategies.
• Knowledge of medical loss ratio (MLR) and incentive structures.

Responsibilities

• Support provider performance strategies across risk adjustment, quality measures, MLR, incentive programs, and value-based care.
• Analyze provider and population-level data to identify gaps, trends and opportunities and 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 practices, coding accuracy, and evidence-based care opportunities.
• Align and optimize incentive programs to maximize provider engagement and performance.
• Utilize dashboards and job aids to support provider engagement and internal team effectiveness.
• Ensure consistent execution of performance initiatives across provider groups and regulatory alignment.
• Travel as required to support provider performance initiatives (approximately 60%).

Skills

Healthcare data analysis

Provider performance

Risk adjustment

HEDIS/STAR knowledge

Education

Bachelor's degree in health-related or business-related discipline

Job description

BlueCross BlueShield of Tennessee, Inc. is seeking a Sr. Provider Performance Specialist to support eastern value-based provider groups, using analytics to drive quality, risk adjustment and population health improvements.

You’ll advise providers and collaborate with stakeholders to implement data-driven strategies that improve outcomes while managing incentive programs. The role requires strong analytical and relationship-management skills, experience with HEDIS/STAR programs, and the ability