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Provider Data Specialist

Blue Cross Blue Shield of Kansas

Topeka, Kansas

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JOB DETAILS
SKILLS
Analysis Skills, Certified Professional Coder (CPC), Communication Skills, Contract Management, Corrective Action, Customer Support/Service, Data Analysis, Data Quality, Database Technology, Dental Insurance, Detail Oriented, Finance, Fitness, Healthcare, Healthcare Administration, Healthcare Providers, High School Diploma, IBM DB2, Incentive Programs, Leadership, Maintain Compliance, Operational Strategy, Operational Support, Pricing, Problem Solving Skills, Process Improvement, Project/Program Management, Provider Contracting, QMF, Record Keeping, Reimbursement, SQL (Structured Query Language), System Test, Team Player, Time Management, Training Program, Training/Teaching, Vision Plan
LOCATION
Topeka, Kansas
POSTED
1 day ago
Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

You Belong At Blue

Why Join Us?

  • Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
  • FamilyComes 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 preferred.
  • Experience with PES and code maintenance preferred.
  • Advanced Excel skills required.
  • Demonstrated stakeholder manage

About the Company

B

Blue Cross Blue Shield of Kansas

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