Provider Data Specialist

Blue Cross and Blue Shield of Kansas is looking to add to our Medical Economics team and has an opportunity for a Provider Data Specialist. This position carries the primary responsibility for the coordination, implementation and maintenance of electronic records utilized for payments to providers, and to support Blue Cross Blue Shield Association provider data.

The position manages and maintains provider contracting agreements and records. This role plays a critical part in ensuring that provider payments are aligned with contractual agreements and pricing updates.

“This position is eligible to work remotely (8 or less days a month onsite) or hybrid (9 or more days a month onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

• Family Comes First: Total rewards package that promotes the idea of family first for all employees; including paid time off and family first leave.
• Professional Growth Opportunities: Advance your career with ongoing training and development programs both through our internal Blue University and external opportunities.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.

• 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.

• Maintains high performance standards to ensure task accuracy and timely completion of deadlines.
• Proactively identifies and notifies about providers with unsatisfactory licensing or certification statuses.
• Secures information that is utilized to create the required payment records in the Provider Entry System (PES) which feeds to CSI/Provider Suites and ensures that information is accurate and reliable.
• Collaborates with Pricing Maintenance staff to maintain and update specialty pricing for provider groups as needed.
• Perform system and data testing/validation to identify deficiencies and invalid data. Provides input, analyses, and recommendations for system modifications as necessary.
• Working in Excel and Data Base II or QMF to pull reports and respond to management requests for data upon training completion.
• Collaborate with Provider Network Services (PNS), Reimbursement/value-based staff, and Claims staff to provide input, analyses, and recommendations for provider updates and/or correction of data.
• Responsibilities include accurate update to provider records for instate, contracting providers and possible pricing updates that may be unique to each provider.
• Ensures compliance with health care regulations and updates in provider payment systems to reflect changes in policy.

• High school diploma or GED required.
• Minimum of two years of experience in claims, customer service, or medical practice management required.
• Understands member benefit descriptions as they relate to all contracted provider programs.
• The ability to fully understand provider participation rules, contractual arrangements, and the general workings of the Competitive Allowance Plan (CAP), and other provider contracted networks.
• Advanced skills in self-direction, interpretation and independent decision-making skills and the ability to perform sound research to develop logical conclusions.
• Learn and master the use of electronic pricing and provider record systems, ensuring accuracy and compliance in provider data.

• Bachelor's degree in healthcare administration, finance, or related field preferred.
• Experience in Data Base II and QMF programming language abilities preferred.

• An understanding of our plan benefits and interpretation of provider contracting agreements preferred.

• Base pay 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