Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience.  Some of our offerings include:

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute

• Annual incentive bonus plan based on company achievement of goals

• Time away from work including paid holidays, paid time off and volunteer time off

• Professional development courses, mentorship opportunities, and tuition reimbursement program

• Paid parental leave and adoption leave with adoption financial assistance

• Employee discount program

Job Description Summary:

The Senior Provider Data Management Specialist plays a critical role in ensuring the integrity, accuracy, and timeliness of provider demographic and contract data within Blue KC systems. This senior-level position requires advanced knowledge of provider data processes, regulatory requirements, and cross-functional collaboration. The Senior Specialist serves as a subject matter expert, leads complex data initiatives, mentors junior team members, and drives continuous improvement in data quality and operational efficiency.

Job Description

• Lead and execute complex provider data updates, including:

  • New practitioners, groups and facilities

  • Value-based program participation

  • Change of Ownerships

  • Network affiliations and PCP assignments

  • Provider updates and terminations

  • Serve as a primary point of contact for escalated provider data issues, ensuring timely resolution and root cause analysis

  • Respond to provider questions received via the General Inquiry Form

  • Review and update of Provider Update Forms

  • Customer Service Inquiries

• Collaborate with internal departments (e.g., Claims, Customer Service, Credentialing, Contracting) to resolve operational issues such as:

  • ASK ERA verifications and entries

  • Returned mail and checks

  • IRS/TIN matching errors; 1099 corrections

  • Dental GRID error reports

  • sPayer tasks

  • Claims routed to MCOs

  • EFT/ERA setups

  • Uncashed checks

  • Customer Service Inquiries

• Oversee and maintain records that cannot be loaded systematically, including roster maintenance and address standardization

• Perform advanced data integrity checks and lead cleanup initiatives to ensure system accuracy

• Monitor team workflows, identify bottlenecks, and recommend process improvements to enhance efficiency and compliance

• Mentor and train junior staff, sharing best practices and supporting skill development

• Participate in audits, regulatory reviews, and cross-functional projects as a provider data SME

• Monitor and handle the workflow for 90 Day Provider Verification Updates, involving direct contact with the provider, running reports, providing roster data to provider, confirming compliance and notification to other areas if a provider reaches suspension status

Minimum Qualifications

• Bachelor’s degree in Healthcare Administration, Business, or related field, or equivalent combination of education and experience

• Four or more years of experience in provider data management or healthcare operations

• Deep understanding of provider network structures, healthcare systems, and regulatory requirements

• Proven ability to manage complex data workflows and resolve high-impact issues

• Strong analytical, organizational, and communication skills

• Critical thinking skills

• Proficiency in Microsoft Office Suite, especially Excel and Word

• Experience with provider data platforms (e.g., Facets, sPayer)

Preferred Qualifications

• Experience leading projects, mentoring/training team members

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.