Provider Regulatory & Data Integrity Consultant
Welcome to the Latest Job Vacancies Site 2024 and at this time we would like to inform you of the Latest Job Vacancies from the Blue Cross and Blue Shield of Kansas City with the position of Provider Regulatory & Data Integrity Consultant - Blue Cross and Blue Shield of Kansas City which was opened this.
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This position will also facilitate creation and maintainance of all department policies and procedures on an annual and ad hoc basis to maintain compliance with ...
- 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: This position is responsible for mitigating risk associated with provider demographic data, and other compliance and regulatory agencies thereby reducing the possibility of sanctions and/or fines wherever possible. The position is also responsible for the processes and maintanence of Blue KC’s network provider data with the highest degree of accuracy and timliness. This position will also facilitate creation and maintainance of all department policies and procedures on an annual and ad hoc basis to maintain compliance with NCQA® and CMS, including Blue KC’s transition of care process and standards. This position must ensure that the department is 1) operating within all standards; 2) provider directories and reports are up-to-date and accurate, and 3) that network adequacy is tracked and deficiencies are addressed immediately. Job Description
- Being familiar and up-to-date with all regulatory and business rules that apply to Blue KC’s provider networks (including network adequacy, access and availability), directories, transition of care standards and provider-related policies—identify impacts, assess risk, and develop recommendations for addressing changes in these areas.
- Having a thorough understanding of all Blue KC’s provider networks, their operations, data configurations and work flows—including all internal and external operating partners.
- Exercising oversight for the integrity of provider data in Blue KC’s and operating partners systems—including the set up of new contracts, the submission of demographic changes, and the management of the quarterly outreach projects.
- Configuring provider data solutions across all networks—facilitating cross-functional teams as needed to drive to a solution.
- Ensuring accuracy and timely maintenance of all Blue KC’s online and print directories.
- Monitoring that all network adequacy reports are received timely by the MA compliance team as well as any deficiencies are addressed in timely manner.
- Maintaining and communicating changes to transition of care standards as required.
- Tracking and reporting quality and timeliness measures to provider relations management and executive teams
- High school degree
- Three years of provider network and/or demographic data set and maintenance experience
- Working knowledge of provider network demographics
- Competency in setting up and maintaining provider networks and demographics in Facets
- Working knowledge of care standards and policy and procedure documents
- Strong analysis, research and investigative skills
- Problem-solving skills
- Outreach and relationship management skills
- Effective written and oral communication skills—appropriate for all levels of management
- Two year degree or higher
- Two years of project management experience
- Two years of complex problem-solving experience
Information :
- Company : Blue Cross and Blue Shield of Kansas City
- Position : Provider Regulatory & Data Integrity Consultant
- Location : Remote
- Country : US
How to Submit an Application:
After reading and knowing the criteria and minimum requirements for qualifications that have been explained from the Provider Regulatory & Data Integrity Consultant job info - Blue Cross and Blue Shield of Kansas City Remote above, thus jobseekers who feel they have not met the requirements including education, age, etc. and really feel interested in the latest job vacancies Provider Regulatory & Data Integrity Consultant job info - Blue Cross and Blue Shield of Kansas City Remote in 17-03-2024 above, should as soon as possible complete and compile a job application file such as a job application letter, CV or curriculum vitae, FC diploma and transcripts and other supplements as described above, in order to register and take part in the admission selection for new employees in the company referred to, sent via the Next Page link below.
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Post Date : 17-03-2024
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