Provider Network Analyst

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.

• Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire

• Professional Growth Opportunities: Advance your career with ongoing training and development programs.

• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.

• Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.

• Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.
   

Benefits & Perks

• Base compensation is only one component of your competitive Total Rewards package

• Incentive pay program (EPIP)

• Health/Vision/Dental insurance

• 6 weeks paid parental leave for new mothers and fathers

• Fertility/Adoption assistance

• 2 weeks paid caregiver leave

• 401(k) plan matching up to 5%

• Tuition reimbursement

• Health & fitness benefits, discounts and resources

Job Summary

Position is responsible for providing support to Provider Network Solutions by conducting network and system analysis including producing, analyzing, interpreting, and using reports needed to provide validation, trending, gap analysis and filings necessary for the review and adherence of network adequacy and performance requirements. Ensures compliance and supports medical review activities and decisions to ensure business practices align with ICD-10 coding. Analysis performed in this role directly supports network contracting and maintenance initiatives. This position directly allows BCBSKS to monitor, comply, and follow CMS network adequacy standards for provider networks and MS-DRG grouper application and support. Direct interaction with Compliance/Legal and BCBSKS senior management in addition to vendors, and federal government programs. Position requires eligibility to enroll as a contractor for BCBSKS to create and maintain an HPMS and CMS contractor profile through secure government websites.

“This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

What you’ll do

• Responsible for development and oversight of Network Adequacy and Accessibility Analysis (gap analysis)

• Collects, interprets and evaluates corporate and BCBSKS network partner data, analyzes, reports provider network accessibility and strength for both internal and external reporting

• Coordinates and completes Provider Network Solutions network adequacy filings jointly and as directed by corporate compliance

• Supports ongoing monitoring of CMS Network Access Plan, identifying and implementing strategies to address gaps in the provider network

• Employ statistical skills and knowledge to anticipate and prepare for adequacy changes correlated to network contracting initiatives providing business and network analysis, recommendations and obstacle aversion opportunities

• Assist in development of business practices to align with industry standards through collaboration across BCBSKS business areas to ensure alignment of interpretation and use of CMS standards and code application

• Create and maintain display dashboards to openly share network adequacy and contracting partner scorecards, current state status and trends, outliers, and areas of improvement for future state, weighing known regulatory changes and contracting initiatives for a variety of provider network stakeholders

• Conducts surveys of providers and community stakeholders to determine adequacy of services, provider experience, and strengths or needs within the provider network

• Provide project management support, support quality improvement projects, encourage data integrity.

What you need

Knowledge/Skills/Abilities

• Strong analytical, organizational, planning, and problem-solving skills

• Understand and apply statistical inference

• Working knowledge of data languages such as SAS or SQL

• Ability to perform detailed research and apply independent evaluation of dependencies and/or relational and sequential data sets to understand and interpret data outcomes

• Knowledge of CMS network measurements, requirements, and reporting preferred

• Ability to effectively communicate and interface with employees at all levels, must have proficient understanding of medical terminology/technology

• Understanding of balance-based problem and solution outcomes

• Demonstrated strengths of advanced presentation skills and analysis-based report writing

• Must embrace and demonstrate the company’s core competencies and values of integrity, dependability, service, growth and progress, and courage. 

Education and Experience

• Bachelor's degree in Business Administration, Economics, Health Care, Information Systems, Statistics, or related field is required. Master’s degree in related field is preferred.

• Four (4) or more years of experience in related position is required

• Exposure and knowledge of CMS network adequacy requirements preferred

• Excellent verbal and written communication and human relation skills with the ability to interact and communicate effectively to include report writing and lead stakeholder presentations

• Current American Academy of Professional Coders (AAPC) credentials as Certified Professional Coder (CPC) preferred

• Must be able to obtain and maintain certification as CMS contractor within 3 weeks of starting position

Physical Requirements

• Position is mostly stationery; PC work up to 95% of workday inclusive of online meeting attendance.

• For onsite position assignment, sit / stand desk is available.

• For candidates eligible for work from home or hybrid telecommuting status, onsite attendance at our main campus can be requested as a condition of this position at any time. Must be able to travel as requested.

Compensation

$85,600 - $107,000

Exempt Grade 16

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid.  All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Our Commitment to Connection and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.