Position will be a key role on BCBSKS’s emerging Affordability team. Leads and executes Blue Cross and Blue Shield of Kansas payment integrity and total cost of care initiatives across the health plan through the affordability command center by working closely with the organization to administer new operating model and governance. The candidate will be a core part of the team defining department strategies, driving projects within the Affordability program, leveraging analytics to drive outcomes, and champion change management planning and execution. This role will work closely with leadership cross-divisionally to ensure overall cost of care is affordable for Kansans. The role requires gaining an in-depth knowledge of organizational capabilities and how they correlate to different functions.

This position is eligible to work hybrid. remote 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.

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Lead and Inspire: Guide and mentor your team to achieve their full potential and success.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
• Stability: 80 years of commitment, compassion and community
• Flexibility: options to work onsite, hybrid or remote available
• Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire

• Leads with direct accountability for ideation and execution of the payment integrity initiatives. Contributes to success of organization wide affordability initiatives.
• Provides subject matter expertise on how to drive cost reduction and increase accuracy of provider payments leveraging data analytics and keeping the cost of healthcare more affordable for our customers.
• Leads development of new initiatives and ensures they are articulated, captured, documented and managed through the SNOW process to deployment.
• Proactively identify ways, means, and platforms to develop payment integrity improvement processes around physician, hospital, and ancillary network contract negotiation strategies, utilization management efforts, new products, annual benefit design participation, and financial operations.
• Drives the identification of potential payment integrity savings opportunities through complex analytics via partnering with the payment integrity analytics team, to developing action plans, benefits and risk assessments and overseeing and partnering with the actuarial team to develop and ensure accurate savings quantification to support clear communication across different components of business.
• Develops and manages technology platforms to plan, lead, oversee payment integrity planning meetings and track and report on payment integrity projects under the Affordability portfolio.
• Champions payment integrity initiatives, negotiates for human capital resources, and partners with care management, claims, IT, and business partners for effective change management.
• Manages portfolio of PI vendors
• Advises senior leadership on the health of payment integrity project portfolio and continuous alignment with future roadmap for on-going savings and enhanced member experience.

• Requires a BS/BA degree; and minimum of 9 years relevant experience in Health Care; or any combination of education and experience, which would provide an equivalent background.
• Prior experience with provider network contracting, provider networks, claims, finance, and operations.
• Experience leading projects and processes with a focus on change management.
• Knowledge of coding and clinical payment methodology or other coding/clinical experience.
• Self-starter who takes initiative and ownership and anticipates future consequences and trends accurately.

• Strongly prefer financial, business, and leadership acumen.

April 9, 2024 Salary