Job Description Summary: This position is a key partner in developing and implementing programs for provider engagement, communication, and other strategic initiatives. This position works closely and collaborates with other leaders throughout the organization to determine strategic priorities for Blue KC to influence care delivery strategies, quality programs and network engagement. This position is key in establishing productive relationships with the provider community.
Job Description - Defines strategy and directly manages relationships between key provider entities including physician groups, hospitals, and ancillary providers. Meets independently with providers to engage at a detailed level representing the company's best interest.
- Supports the implementation of healthcare redesign, provider reimbursement and partnership strategies, and manages healthcare costs while improving outcomes and the healthcare experience for our members.
- Day to day oversight of provider payment solutions and provider account executive (PAE) activities.
- Works collaboratively with other areas to assist with provider engagement activities supporting population health management and value-based contracting.
- Presents information such as strategic concepts, planning data, medical expense/reimbursement rates, provider performance metrics and impact assessments to both internal and external audiences at all levels, including senior leadership.
- Accountable for the design, implementation, and operations of Blue KC's provider issue resolution team.
- Responsible for the daily oversight of the service model impacting provider satisfaction, collaborates with internal and external business partners to ensure staff performance on aligned operations functions and communicates with Blue KC's leadership on staff's provider engagement and performance.
- Engages with PAE's on issue resolution to ensure issues are handled timely with a positive outcome.
- Supports PAE's with resources to escalate provider issues that require business partners engagement for resolution
- Oversees and manages staff educational needs affecting staff and providers
Minimum Qualifications- Bachelor's degree in business administration, health care administration or other relevant academic discipline
- 5 years of Provider Team, Healthcare or Managed Care Experience, may be combined experience
- 5 years of management experience
- Extensive knowledge of Managed Care Processes, Claims Adjudication, Provider Experience
- Advanced level knowledge of and ability to use Microsoft Windows and Office applications such as Word, Excel, Access, and PowerPoint
Preferred Qualifications- 7 years of Provider Team, Healthcare or Managed Care Experience, may be combined experience
- 7 or more years of management experience
