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In this role, you will lead strategic efforts to ensure the accuracy, integrity, and usability of provider data within the provider data management ecosystem. You’ll serve as a subject matter expert in provider data management, credentialing, and payment systems, translating complex data initiatives into actionable strategies that support compliance with Blue Cross and Blue Shield Association (BCBSA), regulatory, and business requirements.
You will oversee provider data operations, manage vendor relationships, and collaborate with cross-functional teams to drive data quality improvements. Your leadership will be key in aligning provider data with enterprise goals, ensuring it supports operational efficiency, regulatory compliance, and a seamless provider and member experience.
Required:
Preferred:
a. Utilize data from Network Administration and provider data partner sources to maintain provider data integrity, functionality, and requirements. Collaborate with Team Leaders and other business partners to track and correct any issues.
b. Interpret and summarize relevant data from multiple sources to conduct comprehensive, collaborative analysis. Produce concise compilation of the analysis, providing implications and recommendations as appropriate to key decision makers.
c. Understand changes to regulations and compliance requirements that would impact Provider Data Accuracy. Support leadership in communicating these changes to team members, vendors, and business partners.
d. Build relationships and effectively manage relationships with vendor(s) supporting the Provider Data Accuracy ecosystem. Communicate to them any new or revised requirements and ensure effective implementation. Monitor and manage applicable SLAs and KPIs.
e. Maintain collaborative relationships with other internal stakeholders across the organization including the Product team, Operations Business Support team, Network Contracting and Technology to ensure business needs are met and provider data is communicated clearly and accurately.
f. Support adherence to compliance and regulation by providing complete and accurate data extracts and data reporting as requested by NCQA, CMS, TriWest, and other auditors.
g. Represent Network Administration as a provider data expert in enterprise projects. Communicate project goals, system and process changes, timelines, and outcomes with leadership.
h. Collaborate within and outside of Operations to coordinate and drive Administration Program Increment (PI) planning deliverables.
i. Other duties as assigned.
An Equal Opportunity Employer
The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]
Please inform us if you meet the definition of a " Covered DoD official ".
At this time, Wellmark is not considering applicants for this position that require any type of immigration sponsorship (additional work authorization or permanent work authorization) now or in the future to work in the United States. This includes, but IS NOT LIMITED TO: F1-OPT, F1-CPT, H-1B, TN, L-1, J-1, etc. For
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