Strategic Provider Relationship Analyst

Company: Blue Cross and Blue Shield of North Carolina
Location: Chapel Hill
Posted on: April 20, 2025

Job Description:

Job DescriptionImplements strategic activities targeted at professional, institutional and ancillary providers for a specific geographic region. Responsible for ensuring adherence to the negotiated agreement for all provider types for all BCBSNC products. Primarily responsible for: 1) Building strong strategic relationships with key decision makers in the provider community enabling BCBSNC to become market leading. 2) Retaining a competitive provider network through innovative approaches to reducing provider transaction costs and 3) Attaining best in claim status for relationship management and service satisfaction for the NC provider community. 4) Through collaboration with other BCBSNC departments responsible for provider service, deployment of a comprehensive service model resulting in higher provider satisfaction, reduction of duplicates service offerings and consistent provider communication messages. 5) Responsible for provider contracting activities/duties for select statewide providers for specific corporate initiatives such as point of care lab technology, virtual care, and other enterprise provider centric initiatives once approved by senior management.What You'll Do

• Support and implement a three-year plan representing:
  * Strategic focus areas within NM* Clear, concise and practical goals and objectives* Supporting metrics and tactical plans
  • Support the development and promote the implementation of new provider payment models and reimbursement methodologies for managed care programs and products. Conducts financial and other quantitative analysis to ensure agreements are implemented efficiently and correctly.
  • Analyzes the negotiated agreement to ensure implementation and reimbursement is completed accurately. Assists management with analysis and prioritization of areas of implementation and predict with reasonable accuracy expected financial results.
  • Support the development and make recommendations for effective formats for providing education and programs to the provider community. Mediums available include printed materials, verbal and written presentations, and web based formats.
  • Responsible for managing a strategy to schedule, plan and visit specific network providers to:
  • Present or reiterate the BCBSNC medical and/or administrative policies and procedures;
    *Address provider inquiries and concerns
    *Disseminate information
  • Address specific "non-compliance" issues with BCBSNC agreements and coordinate the required corrective action.
  • Support the development and execution of meaningful provider workshops and education events.
  • Support the development and execution of methods to gauge provider satisfaction with education staff, materials, and processes. Analyze and execute improvement plans.
  • Timely management of resolution of large-scale issues for key providers. Makes recommendations to BCBSNC leadership on process improvements to enhance provider partner relationships.
  • Identify, analyze and resolve complex high dollar operational issues impacting professional, hospital, ambulatory surgical center, and ancillary providers. Use the appropriate Stakeholder Service Model to increase provider satisfaction and reduce administrative costs.
  • Identify opportunities to control medical expense and deploy action plans to accomplish stakeholder-specific or regional medical expense goals.
  • Represent BCBSNC in critical stakeholder meetings to address stakeholder administrative inefficiencies and to ensure contractual compliance. Participate in negotiations with stakeholders as needed.
  • Assist in the analysis of all products, identify any deficiencies and make recommendations for improvement.
  • Provide analysis and feedback for technologies, trends, best practices and service offerings to incorporate them into overall stakeholder business solutions.
  • Plan all on-site visits to stakeholders to educate on BCBSNC medical or administrative policies and procedures. Address stakeholder concerns and non-compliance contract/administrative issues. Coordinate the required corrective actions.
  • Partner with assigned stakeholders to understand their processes, procedures and systems as they relate to the way they conduct business with BCBSNC.
  • Develop and maintain extensive knowledge of key stakeholders and/or regional territories. Leverage knowledge base to forward Enterprise relationships with stakeholders.
  • Track stakeholder issues for root-cause analysis, escalation, and closure. Document issue resolution using issue resolution protocol.
  • Comply with state, federal and BCBSA regulations governing stakeholders and suggest implementation of any product, process or system modifications to ensure compliance.What You Need
    • Bachelor's degree or advanced degree (where required)
    • 3+ years of experience in related field.
    • In lieu of degree, 5+ years of experience in related field.What We're Looking For
      • Proven experience in developing and implementing strategic plans with clear goals, objectives, and supporting metrics.
      • Experience representing the organization in stakeholder meetings, ensuring contractual compliance, and participating in negotiations.
      • Familiarity with Medicaid, Medicare, D-SNP strongly preferred
      • Experience with contracts/contract negotiating in healthcare setting strongly preferred
      • Proven track record in managing relationships with network providers, addressing inquiries, disseminating information, and resolving non-compliance issues.
      • Ability to analyze products, identify deficiencies, and recommend improvements.Salary RangeAt Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.*Based on annual corporate goal achievement and individual performance.
        $55,800.00 - $89,300.00Required
        Preferred

        Job Industries

        • Other

Keywords: Blue Cross and Blue Shield of North Carolina, Raleigh , Strategic Provider Relationship Analyst, Professions , Chapel Hill, North Carolina