Provider Data Specialist

Blue Cross and Blue Shield of Kansas•Topeka, KS

16h•Hybrid

About The Position

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.

Requirements

High school diploma or GED required
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.
Experience with DB2/QMF/SQL required
Advanced Excel skills required.
Demonstrated stakeholder management and cross functional collaboration experience.

Nice To Haves

Bachelor's degree in healthcare administration, finance, business, or a related field preferred
CPC certification preferred.
experience with PES and code maintenance preferred.

Responsibilities

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.