Blue Cross and Blue Shield of Kansas is looking to add to our provider records team and has an opportunity for a Supervisor Provider Records. This position is responsible for the accuracy and completeness of professional provider records. This position will oversee provider records staff and participate in the maintenance of the professional provider pricing and payment records, and auditing activities.
The position impacts accuracy, completeness, and timely delivery of provider records and accurate pricing for the payment of claims, Blue Cross Blue Shield Association requirements and Provider data files.
“This position is eligible to work remotely (8 or less days a month onsite) or hybrid (9 or more days a month onsite) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.” Remote work will be considered once training is complete.
Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.
Why Join Us?
- Family Comes First: Total rewards package that promotes the idea of family first for all employees; including paid time off and family first leave.
- Professional Growth Opportunities: Advance your career with ongoing training and development programs both through our internal Blue University and external opportunities.
- Trust: Work for one of the most trusted companies in Kansas.
- Lead and Inspire: Guide and mentor your team to achieve their full potential and success.
Compensation
$30.11 - $35.80
Non-exempt Grade 14
- Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.
What you’ll do
- Subject matter expert in enhancing and creating efficiencies through the Provider Entry System (PES) and other impacted systems.
- Leads and coaches professional records staff in daily activities related to the proper maintenance, updating, and retention of provider records.
- Participates in BCBSA National Program mandated changes, system, and record changes to support federally mandated provider transparency.
- Collaborates with Professional Relations staff to determine provider eligibility and make notifications for unsatisfactory licensing board status.
- Works closely with Internal Operations and Provider Network Services to improve business functionality and system interaction between PES and IPS 2.0.
- Articulates business requirements and assists or delegates system testing.
- Serves as the point of contact and subject matter expert for provider system changes, updates, and enhancements.
- Researches, analyzes, and provides recommendations for provider system modifications to meet Blue Cross Blue Shield Association requirements for Provider Data Files.
- Performs or delegates testing of business requirements to improve provider systems, records, and directories.
- Accountable for performance monitoring, policy enforcement, termination process, disciplinary action, hiring, compliance and team development. Maintaining accurate records of all hiring, firing and disciplinary actions.
What you need
- High school diploma or GED required.
- Two years of experience working with provider data, medical review, or areas of operations such as customer service, membership, or claims required.
- Two years leadership or management experience required.
- Position requires extensive keying, sitting, bending, and stooping, with some lifting.
- Up to 90% of a day could be spent at a PC keying.
- Proficient in using client-server-based systems, such as Provider Entry System, BluECM, and CSI.
- Ability to understand provider participation rules, contractual arrangements, and the workings of Competitive Allowance Plan (CAP), HEDIS requirements, Value-Based, and other provider contracted networks.
- Ability to learn and understand electronic pricing and provider record file management methods to confirm pricing and provider record information.
- Advanced self-direction skills and ability to perform research to develop logical conclusions.
- Extensive documentation skills and advanced interviewing techniques.
- Proven organizational skills to meet and maintain goals and objectives.
- Ability to maintain desk procedures and suggest or implement process improvements as needed.
- Trained in the use of computers and knowledgeable in database analysis tools with the ability to manage data across multiple computer databases.
Bonus if you have
- Experience with Data Base II and QMF programming language preferred.
- Broad knowledge of medical and dental terminology, professional protocol, medical economics, and business practices of professional and institutional providers preferred.
- Understanding of out-of-plan benefits and interpretation of provider contracting agreements preferred.
- Knowledge of CAP pricing, including incentive-based programs, and rules for other provider contracts preferred.
- Advanced communication, composition, and presentation skills preferred.
- General knowledge of URAC (Utilization Review Accreditation Commission) guidelines preferred.
Benefits & Perks
- Base pay 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
- 5% 401(k) plan matching
- Tuition reimbursement
- Health & fitness benefits, discounts and resources
Our Commitment to Diversity, Equity, Inclusion, and Belonging
At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of diversity, equity, inclusion, and belonging (DEIB), where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.
We believe that embracing diversity and authentically promoting inclusion, equity, and belonging among our team members is crucial to our collective success. By intentionally recruiting, developing, and retaining a diverse pool of talent, we cultivate an environment where everyone feels valued, heard, and empowered to contribute. Accommodations are available for applicants with disabilities upon request, ensuring an inclusive and accessible hiring process for all.
