Sr. Provider Performance Specialist

bcbst; United States; On-site; USD 95,000 - 125,000; Full time

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%).

Skills

Data analysis

Risk adjustment

Provider consulting

Financial drivers

Analytics translation

Education

Bachelor's degree

Job description

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.

Job 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).

Job Qualifications

Education

Bachelor's Degree in a Health-Related or Business-Related Discipline or equivalent work experience required.

Experience

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.

Skills & Competencies

• 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
• N/A

Number of Openings Available: 1

Worker Type: Employee

Company: BCBST BlueCross BlueShield of Tennessee, Inc.

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices