Hybrid Provider Data Quality Specialist

Blue Cross & Blue Shield of Kansas, Inc.; Topeka (KS); Hybrid; USD 69,117,000 - 81,951,000; Full time

Benefits offered by this job

Health/vision/dental insurance

Parental leave

Fertility/adoption assistance

Caregiver leave

401(k) matching 5%

Tuition reimbursement

Wellness benefits

Job summary

Blue Cross and Blue Shield of Kansas seeks a Quality Analyst to ensure provider records are accurate and compliant with regulatory requirements. You will audit production records and log data errors with recommended improvements to the system management team.

Training is onsite for at least 90 days. After training, this position is eligible to work hybrid or onsite per our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate.

Qualifications

• Ability to write procedural documents as training manuals.
• Ability to review audit language and regulatory requirements to form actionable procedures for data review.
• Excellent verbal and written communication and human relation skills with the ability to interact positively with all levels of internal and external customers.
• Ability to perform detailed research and gather supporting documentation to understand and interpret procedural work assignments.
• Proven ability to work as a member of a team and assist in meeting departmental goals and objectives.
• Work requires good organizational skills and ability to work independently, with a high level of integrity and accuracy.
• Ability to prioritize work to meet organizational objectives.
• Must have excellent verbal and written communication skills, with the ability to interact positively with all levels of clients and staff, both internally and externally.
• Must be able to learn quickly and work independently and as an integral part of a team.
• Must always maintain a positive attitude and outlook, including times of environmental change and increased workloads.
• Must have advanced working knowledge of provider data systems, including but not limited to, Integrated Provider System (IPS) and BluECM workflow within six months of employment to allow position to author system enhancements needed to foster data accuracy.
• Knowledge of all record demographic components and identification and application of source documents.
• Must embrace and demonstrate the company's core competencies and values of integrity, dependability, service, growth and progress, and courage.

Responsibilities

• Research and make recommendations for quality improvement, to correct errors, ambiguities or omissions in training and desk procedures to ensure data accuracy standards are up-to-date and applied in production work.
• Provide feedback to production supervisors and managers regarding recommendations to improve the accuracy of system data.
• Serve as the primary contact for provider data accuracy inquiries from the Association, Federal regulators, and internal audit teams.
• Identify and review statistically valid data samples for each Provider Network team member.
• Track all error categories and report on corrective actions, system support needs, outreach opportunities.
• Document findings on data outreach to support a record pulled for audit.
• Review and identify prioritization of Association and regulatory data errors.
• Complete data updates in provider network system applications.
• Coordinate data accuracy resolution with the institutional relations, professional relations, and provider records.
• Respond to the Association, legal, compliance and Centers for Medicare & Medicaid Services (CMS) upon receipt of the inquiry and the final resolution within established time frames.
• Establish and maintain annual project plans on the continual need to ensure provider data is accurate and providers are engaged in the process.
• Complete electronic provider data sheets to update provider records in the Provider Entry System and CACTUS as needed.
• Participate on the Association conference calls related to provider data.

Skills

Procedural writing

Communication skills

Team collaboration

Organizational skills

Independent work

Attention to detail

Education

High school diploma

Business/Management/Accounting/Communications coursework

Experience with advanced online systems

MS Office (Word, Excel, Access) & Adobe Acrobat

Statistical sampling knowledge

Regulatory language exposure

Tools

Integrated Provider System (IPS)

BluECM workflow

Adobe Acrobat

Job description

Blue Cross and Blue Shield of Kansas seeks a Quality Analyst to ensure provider records are accurate and compliant with regulatory requirements. You will audit production records and log data errors with recommended improvements to the system management team.

Training is onsite for at least 90 days. After training, this position is eligible to work hybrid or onsite per our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate.