BlueAdvantage Network Provider Consultant

Blue Advantage Network Provider Consultant page is loaded
** Blue Advantage Network Provider Consultant
** locations

Flowood, MS    time type

Full time    posted on Posted 5 Days Ago    job requisition idJR
100166    
** Healthy Careers Start Here
** At Blue Cross & Blue Shield of Mississippi, we encourage professional growth in a challenging and fast-paced atmosphere. Our 'be healthy' culture promotes health and wellness at all levels of the Company, and we provide our employees with the time, tools and resources to commit to a healthy lifestyle.
** Job Summary
**** The Blue Advantage Network Provider Consultant serves as a consultant and corporate liaison to Blue Advantage Network Providers, including, but not limited to professional, facility, and allied providers. This role provides consultative services to the Blue Advantage Network Provider community to ensure compliance with Blue Advantage contracts and performance expectations.  This includes sharing of Network Provider performance against Blue Advantage requirements, Centers of Medicare and Medicaid Services (CMS) rules for STARS ratings and clinical improvement of patients to include HEDIS improvement and gaps in care closure.  

The Blue Advantage Network Provider Consultant will also be responsible for ensuring Network Provider compliance to improve administrative and clinical efficiency/effectiveness  to assist in providing the highest quality and most cost effective healthcare to Blue Advantage Members.
**** Job-Specific Requirements:*
* · A Bachelor’s degree in Business Administration, Health Administration, or Nursing.
· At least three (3) years of professional healthcare experience and must possess knowledge of member and provider contract benefits, clinical guidelines, medical policy and claims processing for designated line(s) of business, or possess equivalent healthcare related industry knowledge.
· Medicare Advantage benefit plans experience.
· Experience in working with healthcare providers on improvement in Healthcare Effectiveness Data and Information Set (HEDIS) performance measures.
· Experience with and knowledge of Medicare STARS program to measure health plan and healthcare provider performance.
· Knowledge of the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) risk adjustment model.
· Exhibits professional and positive demeanor with excellent communication.
· Excellent verbal and written communication skills including exemplary presentation skills, development of correspondence, review and management of performance documents etc.
· Ability to travel throughout the state to meet with Blue Advantage Network Providers.
· Demonstrated proficiency in Microsoft Office Suite, especially Excel, Word and PowerPoint.

Blue Cross & Blue Shield of Mississippi is an Equal opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We offer a comprehensive benefits package that is worth approximately one-third of the salary compensation. Our benefits program is among the best in the health care field.

We are looking for employees who can bring their experience, expertise and dedication to work for our customers.

At Blue Cross & Blue Shield of Mississippi, we work daily to help Mississippians find their personal answers to this question through health and wellness partnerships with quality healthcare providers, employer groups and community leaders across the state. Our goal is to help each person along their journey to a healthier life… their Blue Wellness Journey.  Our health and wellness benefits are designed to support our members in understanding their health and in receiving the care they need at the right time and place, beginning with establishing a healthy relationship with a Primary Care Network Provider through an annual wellness visit at no out-of-pocket cost.  

We partner with our Network Providers to ensure the highest quality, evidence-based care is provided in each care setting from primary care to specialty care through our Primary Care Home, Blue Distinction+ Centers of Excellence and Maternity Care Quality initiatives.  We partner with employer groups to make every workplace a healthy workplace by providing tools and information to help employees take ownership of their health and understand and make the most of their benefits, all while working to manage health and healthcare costs.  

We partner with community leaders and organizations to make healthy living resources available to all Mississippians through the work of the Blue Cross & Blue Shield of Mississippi Foundation, our support of the arts and culture and our Team Blue volunteers.  These partnerships and our dedicated team of employees are making a difference every day, in our communities and in the lives of each person we reach.  

Live healthy. Live Blue.
#J-18808-Ljbffr