Provider Account Executive (Kansas City, MO area)

Work At Home - Missouri

Work At Home - Kansas

Work At Home - KCMO

Full time

R6943

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:

Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute

Annual incentive bonus plan based on company achievement of goals

Time away from work including paid holidays, paid time off and volunteer time off

Professional development courses, mentorship opportunities, and tuition reimbursement program

Paid parental leave and adoption leave with adoption financial assistance

Employee discount program

Job Description Summary:

The Provider Account Executive acts as the central point of coordination and integration with key provider partners on behalf of Blue KC. This role is charged with acting as the “quarterback” for the BlueKC Partnership Teams that encompass all traditional and value-based payer-provider functions and interests (i.e. provider analytics, provider payments, demographic registration/demographics, contracting, medical management including pharmacy and compliance). The candidate/employee for this position must reside in the Kansas City metropolitan area.

Job Description

• Build and maintain positive physician/hospital relationships with focus on a collaborative approach to quality care, network development and stability, cost containment and identification and resolution of barriers to success

• Facilitate resolution of escalated or urgent provider issues that are unable to be resolved through standard processes or procedures

• Serves as a liaison to providers regarding contracting issues; ensures consistency with compensation and payment

• Partner with appropriate subject matter experts to share provider’s comments and concerns

• Develop and deliver provider education regarding BlueKC directives, mandates, medical and payment policies, programs, and business needs

• Lead in-person provider visits (create agenda, facilitate meeting, capture action items, send notes and own follow – up to the visits/meetings)

• Collaboration with other internal partners, provider value-added consultation and solutions to assigned providers.

• Includes trends and outliers in populations, determining root causes to variances and summarize in understandable terms.

• Includes presenting at educational conferences, submitting data to newsletters, and provider educational webinars and on-site training to providers

• Present performance data to providers or provider organization management and discuss opportunities to improve performance.

Minimum Qualifications

• Bachelor’s degree in Business, Health Care or related field or an equivalent combination of education and experience

• 5 years of provider relations experience with demonstrated success in developing and maintaining excellent provider relations with all types of providers

• 5 years of experience working with and general understanding of claims coding, medical terminology, ICD and CPT coding systems

• 5 years of experience with health insurance plan, preferred Provider Relations, Marketing/Account Management experience

• Strong verbal and written communication skills

• Strong presentation skills

• Proficient in Microsoft (Word, Excel and PowerPoint)

• Experience with Benefit Designs, Product Offerings, Contracting and Payment Strategy

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

At Blue Cross and Blue Shield of Kansas City (Blue KC), we have long put our members first by developing products and services to meet their needs. From our founding in 1938 to more than 80 years of experience in innovative, patient-centered healthcare coverage, Blue KC continues to keep our members at the center of everything we do. As a market leader, we continue to embrace new ideas to make healthcare more affordable and to improve the customer experience. Come join us!

Blue Cross and Blue Shield of Kansas City will extend reasonable accommodations to qualified individuals with disabilities who are otherwise not able to fully utilize electronic and online job application systems. For assistance, please send an email to [email protected] .

EOE/Veterans/Disability

Affirmative Action Employer

E-Verify Participation (https://bluekcmemberportal.azureedge.net/pdf/2024/E-Verify\_Participation\_Poster\_Eng\_Es.pdf)

Equal Employment Opportunity/Nondiscrimination/Affirmative Action Policies

IER Right to Work (https://www.e-verify.gov/sites/default/files/everify/posters/IER\_RightToWorkPoster%20Eng\_Es.pdf)

FMLA

Employee Polygraph Protection Act (https://www.dol.gov/whd/regs/compliance/posters/eppac.pdf)