BlueAdvantage Network Provider Consultant
Company: Blue Cross & Blue Shield of Mississippi
Location: Flowood
Posted on: April 1, 2026
|
|
|
Job Description:
Healthy Careers Start Here At Blue Cross & Blue Shield of
Mississippi, we encourage professional growth in a challenging and
fast-paced atmosphere. Our 'be healthy' culture promotes health and
wellness at all levels of the Company, and we provide our employees
with the time, tools and resources to commit to a healthy
lifestyle. Job Summary The BlueAdvantage Network Provider
Consultant serves as a consultant and corporate liaison to
BlueAdvantage Network Providers, including, but not limited to
professional, facility, and allied providers. This role provides
consultative services to the BlueAdvantage Network Provider
community to ensure compliance with BlueAdvantage contracts and
performance expectations. This includes sharing of Network Provider
performance against BlueAdvantage requirements, Centers of Medicare
and Medicaid Services (CMS) rules for STARS ratings and clinical
improvement of patients to include HEDIS improvement and gaps in
care closure. The BlueAdvantage Network Provider Consultant will
also be responsible for ensuring Network Provider compliance to
improve administrative and clinical efficiency/effectiveness to
assist in providing the highest quality and most cost effective
healthcare to BlueAdvantage Members. Job-Specific Requirements: · A
Bachelor’s degree in Business Administration, Health
Administration, or Nursing. · At least three (3) years of
professional healthcare experience and must possess knowledge of
member and provider contract benefits, clinical guidelines, medical
policy and claims processing for designated line(s) of business, or
possess equivalent healthcare related industry knowledge. ·
Medicare Advantage benefit plans experience. · Experience in
working with healthcare providers on improvement in Healthcare
Effectiveness Data and Information Set (HEDIS) performance
measures. · Experience with and knowledge of Medicare STARS program
to measure health plan and healthcare provider performance. ·
Knowledge of the Centers for Medicare & Medicaid Services (CMS)
Hierarchical Condition Category (HCC) risk adjustment model. ·
Exhibits professional and positive demeanor with excellent
communication. · Excellent verbal and written communication skills
including exemplary presentation skills, development of
correspondence, review and management of performance documents etc.
· Ability to travel throughout the state to meet with BlueAdvantage
Network Providers. · Demonstrated proficiency in Microsoft Office
Suite, especially Excel, Word and PowerPoint. Blue Cross & Blue
Shield of Mississippi is an Equal opportunity Employer. All
qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, sexual orientation,
gender identity, national origin, disability or protected veteran
status. We offer a comprehensive benefits package that is worth
approximately one-third of the salary compensation. Our benefits
program is among the best in the health care field. We are looking
for employees who can bring their experience, expertise and
dedication to work for our customers.
Keywords: Blue Cross & Blue Shield of Mississippi, Hattiesburg , BlueAdvantage Network Provider Consultant, Executive , Flowood, Mississippi
