Provider Data Quality Analyst

Blue Cross and Blue Shield of Kansas; Topeka (KS); Hybrid; USD 55,000 - 78,000; Full time

Benefits offered by this job

Health insurance

Vision/Dental insurance

6 weeks paid parental leave

Fertility/Adoption assistance

2 weeks paid caregiver leave

401(k) match up to 5%

Tuition reimbursement

Health & fitness benefits

Job summary

Blue Cross and Blue Shield of Kansas is seeking a Quality Analyst to ensure provider records are created and maintained accurately, meeting BCBS Association and federal requirements. The role includes data audits and logging errors to guide system improvements, with onsite training for at least 90 days and then hybrid or onsite work per 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.

Responsibilities

• Research and make recommendations for quality improvement to ensure data accuracy standards.
• Provide feedback to production supervisors and managers regarding data accuracy.
• 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 error categories and report on corrective actions and data outreach.
• Review and identify prioritization of Association and regulatory data errors.
• Complete data updates in provider network system applications.
• Coordinate data accuracy resolution with institutional relations, professional relations, and provider records.
• Respond to the Association, legal, compliance and CMS upon inquiry and resolution within time frames.
• Establish and maintain annual project plans to ensure provider data accuracy.

Skills

Procedural writing

Communication

Audit/regulatory review

Data integrity

Team collaboration

Job description

This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/13681445 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 / Knowledge/Skills/Abilities

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.