Alternative Payment Model Specialist

Blue Cross Blue Shield of Kansas • Topeka, KS • 4h ago

This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/13449333 Blue Cross and Blue Shield of Kansas is looking to add to our Medical Economics team and has an opportunity for an Alternative Payment Models Specialist. This position supports the implementation and monitoring of Alternative Payment Model (APM) provider reimbursement programs, including Accountable Care Organizations, Patient-Centered Medical Homes, and the Quality-Based Reimbursement Program. This role requires collaboration with internal teams, external vendors, and contracted providers to ensure successful execution, identify areas for continuous improvement, and address provider questions and concerns.

\"This position is eligible to work remotely, 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.\"

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

Why Join Us?**

Family Comes First: Total rewards package that promotes the

idea of family first for all employees.

Professional Growth Opportunities: Advance your career with

ongoing training and development programs.

Dynamic Work Environment: Collaborate with a team of passionate

and driven individuals.

Trust: Work for one of the most trusted companies in Kansas

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.

What you\'ll do

Assist in maintaining data structures and reports that support APM

programs.

Provide analytical support for monitoring program performance and

payment calculations.

Respond to provider questions regarding program requirements,

performance, and reimbursement.

Assist with peer review and development of new processes to replace

legacy workbooks.

Support communication and collaboration with internal teams and

external providers.

Develop provider communications for annual incentive updates and

program changes.

Administrative upkeep of program infrastructure and systems.

Maintain and expand upon process documentation.

What you need

High school diploma or equivalent required. Bachelor\'s degree in

Business, Finance, Healthcare Administration, or related field preferred. In lieu of degree, an additional 3 years of relevant experience required.

Minimum 3 years of experience working with alternative payment

models, provider reimbursement, healthcare quality initiatives, or related experience required.

Knowledge/Skills/Abilities

Proficiency in Microsoft Excel required, including working with

formulas and datasets. Proficiency in Microsoft Word required. Proficiency with SQL or other data querying tools a plus.

Understanding of healthcare services, provider reimbursement,

healthcare billing practices, medical terminology, and value-based care concepts.

Strong analytical and problem-solving skills. Ability to interpret

and work with healthcare data.

Effective written and verbal communication skills.

Attention to detail and accuracy in data handling.

Ability to manage multiple tasks and meet deadlines.

Demonstrated ability to take ownership of work and deal with

ambiguity. Collaborative mindset and willingness to learn new processes.

Broad understanding of the healthcare industry, including knowledge

of third-party reimbursement processes, provider relations, and medical economics.

Understanding of HIPAA, CMS, and other regulatory standards

affecting healthcare reimbursement and value-based contracts.

Bonus if you have

Experience with data analysis, financial modeling, and/or healthcare

reimbursement preferred.

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

5% 401(k) plan matching

Tuition reimbursement

Health & fitness benefits, discounts and resources

Our Commitment to Connection and Belonging

At Blue Cross and Blue Shield of Kansas, w

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