Sr. Provider Performance Specialist

We are hiring a Sr. Provider Performance Specialist on our Provider Outreach and Innovation team at BCBST!

In this role, you will support primarily eastern value-based provider groups, partnering directly with provider organizations to assess performance data, identify opportunities for improvement, and drive better quality, risk adjustment, and population health outcomes. You'll serve as a trusted advisor to providers, leveraging analytics, relationship management, and strategic problem-solving skills to help practices succeed in value-based arrangements while delivering measurable results for members and the organization. This position offers the opportunity to influence provider performance, strengthen partnerships, and support healthcare transformation through data-driven decision-making.

To be successful in this role, in addition to the core job requirements, you'll bring strong analytical capabilities, relationship management skills, customer service expertise, and a proactive approach to problem-solving. The ideal candidate is comfortable interpreting performance data, communicating insights to provider partners, and collaborating with stakeholders to implement strategies that improve outcomes.

Note:

• This role supports primarily eastern value-based provider groups.
• Approximately 25% travel is required, primarily for occasional on-site provider visits.
• Sponsorship is not available for this role.

Job Responsibilities

• Support provider performance strategies across risk adjustment, quality measures, medical loss ratio, incentive programs, and value-based care.
• Analyze provider and population-level data to identify gaps, trends, and opportunities for improvement, and support provider-specific action plans through data segmentation and targeted gap closure strategies. 
• Implement targeted strategies to enhance clinical quality outcomes, patient experience, and financial performance.
• Educate and consult providers on quality performance expectations, program requirements, documentation practices, coding accuracy, and evidence-based care opportunities, while resolving complex performance and metric-related issues.
• Align and optimize incentive programs to maximize provider engagement and performance, incorporating quality-based incentives and value-based reimbursement alignment.
• Utilize standardized tools, dashboards, and job aids to support provider engagement and internal team effectiveness, including quality performance reporting and tracking tools.
• Ensure consistent execution of performance initiatives across provider groups, emphasizing quality improvement consistency and best practice adoption.
• Collaborate with internal stakeholders to align strategies supporting quality improvement programs, regulatory requirements, and value-based initiatives.
• Travel as required to support provider performance initiatives (approximately 60% of the time).

Job Qualifications

Education

• Bachelor’s Degree in a Health-Related or Business-Related Discipline or equivalent work experience required.

Experience

• 4 years - Progressive experience in healthcare, quality improvement, or provider performance required.
• Demonstrated experience with risk adjustment, Quality programs (HEDIS, STARS, etc.), value-based care models, and incentive programs or MLR drivers. 

Skills & Competencies

• Advanced healthcare data analysis and performance insight development
• Expertise in risk adjustment, HEDIS/STAR quality programs, and value-based care models
• Strong provider consulting and performance improvement capabilities
• Knowledge of healthcare financial drivers including MLR and incentive structures
• Ability to translate analytics into actionable provider strategies

N/A

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Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.