Blue Cross Blue Shield of Kansas - Topeka, KS
posted 2 months ago
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.