Provider Data Quality Analyst

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

Why Join Us?

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas. 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 position of Quality Analyst is essential in assuring provider records are created and maintained accurately, satisfying Blue Cross and Blue Shield Association and Federal regulatory requirements. Position includes performing data accuracy audits on production records created within the Provider Network team as well as project data mismatch reports. Analyst will identify and log data errors to make to recommendations system management team(s) to correct errors, ambiguities or omissions in training and desk procedures. \"Training will be onsite for at least 90 days. After training is completed, 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

• 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.

What you need

• 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.

Education and Experience

• High school graduate or equivalent required.


• College courses in Business Administration or Management, Accounting or Communications preferred.


• Two years experience in the use of advanced online systems, demonstrating understanding and application of relational systems and data files.


• Working knowledge of Microsoft Suite applications (Word, Excel, Access), Adobe Acrobat required.


• Knowledge of statistical sampling preferred.


• Compliance and regulatory language and requirement exposure (such as contracts, statute and policy language) preferred.

Physical Requirements

Work is complex, requiring continuous concentration in dealing with providers, data consumers and others on a semi-reactionary basis. Minimal lifting (up to 20 lbs), filing and stapling required. Position is mainly stationary with PC work up to 95% of the day.

Compensation

$24.11 - $28.60 hourly 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. 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. For more than 70 years, Blue Cross and Blue Shield of Kansas has built a reputation of trust. As we move forward in this new era of health care we want to continue that tradition. Whether a member needs Blue Cross to cover an annual check-up or give them peace of mind during a major medical crisis, we want our members to know they can trust BCBSKS to meet their needs. Our mission: Being the insurer Kansans trust with their health.