Provider Data Quality Analyst

Blue Cross and Blue Shield of Kansas•Topeka, KS

3d•$24 - $29•Hybrid

About The Position

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.

Requirements

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.
High school graduate or equivalent required.
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.

Nice To Haves

College courses in Business Administration or Management, Accounting or Communications preferred.
Knowledge of statistical sampling preferred.
Compliance and regulatory language and requirement exposure (such as contracts, statute and policy language) preferred.

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