Strategic Provider Relationship Analyst
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Job Description
Provider Relationship Analyst strengthening Medicare Advantage provider networks for Blue Cross NC. Managing contracts, reimbursement analysis, education, compliance, and stakeholder issue resolution.
Responsibilities:
- Develop and execute strategic provider engagement and network initiatives supporting Blue Cross NC Medicare Advantage products
- Build and maintain strategic partnerships with professional, institutional, ancillary, and statewide providers
- Support provider contracting, relationship management, payment model, and reimbursement methodology initiatives
- Conduct financial and quantitative analysis to ensure agreements and reimbursement are implemented accurately
- Develop provider education formats, workshops, presentations, and education events
- Schedule, plan, and conduct provider and stakeholder visits
- Address provider inquiries, concerns, non-compliance issues, and corrective actions
- Manage resolution of large-scale and complex high-dollar operational issues
- Recommend process improvements to enhance provider relationships and reduce administrative costs
- Identify opportunities to control medical expenses and deploy regional or stakeholder-specific action plans
- Represent BCBSNC in stakeholder meetings and participate in negotiations as needed
- Analyze products and recommend improvements based on technologies, trends, best practices, and service offerings
- Partner with stakeholders to understand their processes, procedures, and systems
- Track stakeholder issues through root-cause analysis, escalation, documentation, and closure
- Ensure compliance with state, federal, and BCBSA regulations
Requirements:
- Bachelor's degree or advanced degree where required
- 3+ years of experience in a related field
- In lieu of degree, 5+ years of experience in a related field
- Proven Medicare Advantage experience or experience in a managed care or health plan environment supporting MA products
- Ability to educate and advise providers on Medicare Advantage processes, products, claims, and operational requirements
- Provider-facing or customer service experience
- Ability to build strong cross-functional relationships
- Strong communication skills and ability to explain complex topics and deliver difficult messages professionally
- Authorization to work in the United States
- Ability to work in one of the employer's approved states
Benefits:
- Work-life balance, flexibility, and autonomy
- Medical, dental, and vision coverage
- Health and wellness programs
- Parental leave and support
- Adoption and surrogacy assistance
- Career development programs
- Tuition reimbursement for continued education
- 401(k) match including an annual company contribution
- Annual Incentive Bonus based on annual corporate goal achievement and individual performance
- Paid Time Off (PTO)
- Reasonable accommodations for applicants with disabilities
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