Provider Network Operations Specialist

Blue Cross and Blue Shield of Kansas•Topeka, KS

2d•$24 - $29•Hybrid

About The Position

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.

Requirements

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
Demonstrated verbal and written communication and human relation skills with the ability to interact positively at all levels with internal and external peers.
High school graduate or equivalent is required.
Minimum two years of experience BCBSKS operational experience to include customer service, claims or membership OR 3 years demonstrated experience working with medical insurance is required.

Nice To Haves

Education or experience in communications, human relations, medical terminology, or contract compliance preferred.

Responsibilities

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.