Provider Data Specialist

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You Belong At Blue

Why Join Us?

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
• Professional Growth Opportunities: Advance your career with ongoing training and development programs.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
• Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
• Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.

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
• 401(k) plan matching up to 5%
• Tuition reimbursement
• Health & fitness benefits, discounts and resources

Job Summary

The Provider Data Specialist is responsible for coordinating, implementing, and maintaining accurate electronic provider records that support provider payments and Blue Cross Blue Shield Association provider data requirements. This role manages provider contracting agreements and associated data, ensuring that provider payments align with contractual terms, pricing methodologies, and policy updates.

The Provider Data Specialist plays a critical role in provider data modernization initiatives and contributes analytical insight and recommendations to support data integrity, operational efficiency, and continuous process improvement.

“This position is eligible to work 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.”

What you’ll do

• Coordinate, implement, and maintain electronic provider records used to support accurate and timely provider payments.
• Manage and maintain provider contracting agreements and related records within provider data systems.
• Ensure provider payments align with contractual agreements, pricing updates, and value based arrangements.
• Secure, validate, and maintain provider data used to create payment records in the Provider Entry System (PES) and downstream systems, including CSI/Provider Suites.
• Perform system and data testing and validation to identify deficiencies, inconsistencies, or invalid data; provide analysis and recommendations for corrective actions or system enhancements.
• Monitor, apply, and audit pricing, contract, and policy changes within provider data systems to ensure ongoing compliance.
• Collaborate with Provider Network Services, Reimbursement and value based teams, Claims, and other internal stakeholders to research issues, resolve data discrepancies, and support provider updates.
• Utilize Excel, DB2/QMF, SQL, and related tools to pull reports, analyze data, respond to management requests, and support operational and project needs.
• Participate actively in provider data modernization initiatives, including workflow improvements, system enhancements/trainings, and data governance efforts.
• Contribute insights and recommendations for process improvement, data quality, and operational efficiency.
• Maintain clear, consistent communication with leadership regarding project status, milestones, risks, and outcomes.
• Maintain high performance standards with a focus on accuracy, timeliness, and attention to detail.

What you need

Education and Experience

• High school diploma or GED required; Bachelor's degree in healthcare administration, finance, business, or a related field preferred
• Minimum of two years of experience in claims, customer service, medical practice management, provider network solutions, project management, or a related healthcare operations role required.
• CPC certification preferred.
• Experience with DB2/QMF/SQL required; experience with PES and code maintenance preferred.
• Advanced Excel skills required.
• Demonstrated stakeholder management and cross functional collaboration experience.

Knowledge, Skills, and Abilities

• Strong understanding of provider participation rules, contractual arrangements, and provider network structures, including the Competitive Allowance Plan (CAP) and other contracted networks.
• Knowledge of member benefit descriptions and their relationship to contracted provider programs, including value based agreements.
• Ability to interpret provider contracts and apply contractual logic accurately within provider data systems.
• Strong analytical and critical thinking skills with the ability to research provider and claims based questions and propose effective solutions.
• Proficiency in Excel; strong DB2/QMF and SQL data query and research skills, with a desire to continue developing technical expertise.
• Ability to learn and master electronic provider record and pricing systems while maintaining accuracy and compliance.
• Effective written and verbal communication skills, including the ability to present findings and recommendations to leadership.
• Demonstrated understanding of provider incentive based logic and payment methodologies.
• Strong organizational, self direction, and independent decision making skills.

Compensation

$23.58 - $29.40

Non-exempt Grade 12

• 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.

Our Commitment to Connection and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

Our Commitment to Connection and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.