Provider Solutions Consultant

Benefits

• 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

The Provider Payment Solutions Consultant (PSC) works in partnership with the Provider Payment Solutions team and Blue KC Account Executives and Account Managers across all lines of business to evaluate and monitor Blue KC’s provider service performance and recommend action plans to resolve provider service issues.

• High level of critical thinking and ability to think outside the box to drive resolution.
• Proactively define overall direction, roadmap, and improvement actions for Provider Solutions functions core to the BlueKC business.
• Create and utilize tools to proactively evaluate performance so that actions can be recommended and taken to directly impact the results in a timely manner.
• Accountable for key provider relationships, especially as they relate to claims not paying correctly.
• Identify, triage, and prioritize issues with input from cross‑functional partners.
• Drive solutions for production and payment issues based on an in‑depth understanding of systems and system functionality.
• Regularly conduct research and analysis of provider service issues using performance reports and service data sets; assess issues to determine root causes, impact areas, and make process improvement recommendations.
• Manage action plans to resolve service issues which could lead to new or updated corporate and departmental policies, procedures, and workflows.
• Communicate effectively with team members and team leadership.
• Participate as needed in the Provider Service Management Team, a cross‑functional team designed to discuss, prioritize, and resolve provider service issues.
• Coordinate and facilitate small team efforts within and across departments.
• Develop proactive and positive working relationships with other departments within Blue KC to resolve provider issues.
• Lead meetings with providers to resolve complex issues and review claim action logs.
• Responsible for completing monthly provider service scorecards within timelines and leading data‑integrity audits to ensure scorecard data is reasonable and accurate.
• Track, analyze, and communicate key metrics related to specific issues and projects.
• Independently provide analysis and lead discussion specific to the interaction of clinical reimbursement and benefit strategies for complex, cross‑functional provider payment issues.

• Bachelor’s degree in Clinical Sciences, Business Administration, or a related combination of education and experience that provides the required knowledge, skills, and ability.
• 5–7 years of professional experience working with operational and/or analytic processes, preferably within the healthcare industry or managed pay‑or.
• Strong understanding of Blue KC core systems (including but not limited to Facets, Claims Xten, NetworX).
• Strong understanding of claims, reimbursement, and benefit structures.
• Strong professional communication skills in both oral and written forms.
• Strong knowledge and skills using Microsoft Word, Excel, Access, PowerPoint, or similar PC‑based software.
• Demonstrated organizational, planning, and administrative skills.
• Ability to work under pressure with limited resources, competing priorities, and specific project timelines.
• Self‑starter; ability to work with minimal direction.

• 7 years of professional experience working with operational and/or analytic processes, preferably within the healthcare industry or managed pay‑or.
• Extensive understanding of Blue KC Claims, Reimbursement and Benefit Structures.

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

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.

EEO/Veterans/Disability

Affirmative Action Employer

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Equal Employment Opportunity/Nondiscrimination/Affirmative Action Policies

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