This job was posted by https://www.kansasworks.com : For more
information, please see: https://www.kansasworks.com/jobs/13550151 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.
- FamilyComes 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 etwork
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