Provider Network Operations Specialist

Blue Cross Blue Shield of Kansas

Topeka, Kansas
14 days ago

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Skills

Accreditation Standardsunmatched
Auditingunmatched
Business Solutionsunmatched
Centers for Medicare and Medicaid Services (CMS)unmatched
Communication Skillsunmatched
Data Qualityunmatched
Dental Insuranceunmatched
Documentationunmatched
Federal Laws and Regulationsunmatched
Fitnessunmatched
Healthcare Providersunmatched
Incentive Programsunmatched
Medical Officeunmatched
Microsoft Officeunmatched
Microsoft Product Familyunmatched
Network Administration/Managementunmatched
Network Management Softwareunmatched
Network Supportunmatched
Network Systemsunmatched
Onboardingunmatched
Operating Systemsunmatched
PC (Personal Computer) Systemsunmatched
People Managementunmatched
Product/Service Launchunmatched
Project Planningunmatched
Record Keepingunmatched
Records Managementunmatched
Regulationsunmatched
Regulatory Complianceunmatched
Research Skillsunmatched
Service Level Agreement (SLA)unmatched
State Laws and Regulationsunmatched
Team Playerunmatched
Time Managementunmatched
Training Programunmatched
Training/Teachingunmatched
Vision Planunmatched

Description

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.
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

Supports provider network operations for Blue Cross Blue Shield of Kansas by managing end-to-end provider enrollment and maintenance processes. Performs intake, screening, eligibility review, and timely processing of applications, changes, and terminations while maintaining accurate provider records within Provider Network Solutions systems. Coordinates onboarding with Provider Representatives and tracks contract participation across network offerings. Serves as a resource for providers and internal stakeholders on enrollment and participation guidelines.

"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

Supports provider network operations by managing intake, enrollment, and ongoing maintenance of provider records.
Serves as the initial point of contact for enrollment and maintenance submissions, assigning workflows and responding to provider inquiries to initiate onboarding.
Conducts eligibility research and validation in accordance with Centers for Medicare & Medicaid Services, federal and state regulations, accreditation standards, and organizational requirements.
Executes the full enrollment lifecycle, including application review, verification of licensure, accreditation, NPI registration, and board certification, as well as record creation and onboarding coordination.
Maintains accurate provider records across network management systems, processing updates, changes, and terminations in alignment with compliance standards.
Leads provider data accuracy efforts by performing outreach, resolving discrepancies, and documenting updates to meet regulatory and business requirements.
Conducts audits, supports reporting and audit activities, and contributes to ongoing data accuracy initiatives and project plans.
Provides guidance to providers and internal stakeholders on enrollment processes, network participation, and the importance of maintaining accurate provider data, including use of self-service tools for validation.

What you need

Knowledge/Skills/Abilities:

Must be able to learn and apply network contracting knowledge throughout enrollment processing for BCBSKS owned and serviced contracts.
Ability to work well with multiple active work items and adhere to both complimentary and competing service level agreements.
Ability to communicate effectively and professionally with staff from provider offices, physicians, and all levels of internal staff required.
Employ independent and procedural thinking skills to complete records within defined data entry systems.
Understand sequential workflow procedures.
Work with high degree of accuracy to complete record update processing within defined quality and compliance standards.
Proficiency in utilizing a personal computer is required with knowledge of Microsoft Office suite products.
Proficiency with operating systems and standard business software
Demonstr

Numbers & Facts

Location

Topeka, Kansas

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