Manager Provider Data

$109,280 - $130,000/Yr

Blue Cross Blue Shield of Kansas - Topeka, KS

Full-time - Manager

Remote - Topeka, KS

Insurance Carriers and Related Activities

About the position

Blue Cross and Blue Shield of Kansas has a leadership opportunity on our Medical Economics team for a Manager Provider Data, who will ensure the accuracy and completeness of provider records and oversee the provider data team. This position will oversee provider data staff and participate in the maintenance of the professional provider pricing and payment records, and auditing activities. This role is pivotal in streamlining provider data management processes to enhance accuracy and efficiency. 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. In this role, you will act as the subject matter expert on enhancing and streamlining the Provider Entry System for greater efficiency. You will supervise and coach professional records staff in daily activities associated with proper maintenance, updating, and retention of provider records. Additionally, you will lead the adaptation to BCBSA National Program and federally mandated changes, ensuring provider transparency and compliance. Collaboration with Provider Relations staff will be essential to assist in determining the eligibility of the provider and making proper notifications when there is an unsatisfactory status with the licensing board. You will also work closely with Internal Operations and Provider Network Services to enhance business functionality and ensure cohesive system interaction between PES and IPS 2.0. Your responsibilities will include articulating business requirements and delegating or directly assisting with system testing. You will be the point of contact and Subject Matter Expert for provider system changes, updates, and enhancements. Researching and providing input, analyses, and recommendations for provider system modifications necessary to meet Blue Cross Blue Shield Association requirements for Provider Data Files will also be part of your duties. This includes performing and/or delegating testing of the business requirements to improve provider systems, provider records, and the provider directories. Furthermore, you will develop and implement training programs for staff to ensure high standards in data management and compliance with evolving healthcare regulations.

Responsibilities

• Ensure the accuracy and completeness of provider records.
• Oversee the provider data team and staff.
• Participate in the maintenance of professional provider pricing and payment records.
• Streamline provider data management processes for enhanced accuracy and efficiency.
• Act as the subject matter expert on the Provider Entry System.
• Supervise and coach professional records staff in daily activities.
• Lead adaptation to BCBSA National Program and federally mandated changes.
• Collaborate with Provider Relations staff to determine provider eligibility.
• Work closely with Internal Operations and Provider Network Services to enhance business functionality.
• Articulate business requirements and assist with system testing.
• Research and provide input for provider system modifications.
• Develop and implement training programs for staff.

Requirements

• Bachelor's degree in Business Administration, Healthcare Administration, or a related field is strongly preferred.
• At least three years of experience in provider data management, medical review, or operational areas like customer service, membership, or claims.
• Trained in use of computer and knowledgeable of database analysis tools.
• Experience in Data Base II and QMF programming language abilities preferred.
• General knowledge of URAC guidelines is preferred.
• Previous experience in a direct supervision or leadership role of employees and/or teams is preferred.
• Proficient in client-server based systems, including the Provider Entry System.
• Extensive knowledge of medical and dental terminology, medical economics, and business practices of professional and institutional providers is preferred.
• Understanding of out of plan benefits and interpretation of provider contracting agreements preferred.
• Ability to understand provider participation rules, contractual arrangements, and workings of the Competitive Allowance Plan (CAP).
• Knowledge of CAP pricing and rules for other provider contracts is preferred.
• Ability to learn and understand the full use of electronic pricing and provider record file.
• Advanced communication/composition skills and excellent presentation abilities preferred.
• Advanced skills in self-direction and the ability to perform sound research to develop logical conclusions.
• Must maintain confidentiality and have extensive documentation skills.

Nice-to-haves

• Experience in healthcare regulations and compliance.
• Advanced interviewing techniques.
• Proven organizational skills to assist in meeting goals and objectives.

Benefits

• 401(k) 5% Match
• Adoption assistance
• Caregiver leave
• Dental insurance
• Gym membership
• Health insurance
• Incentive pay program (EPIP)
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• Tuition reimbursement
• Health & fitness benefits, discounts and resources