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Provider Data Quality Analyst Sr

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Blue Cross and Blue Shield of MinnesotaEagan, MN
  • About Blue Cross
  • Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.9 million members.
  • We’re committed to reinventing health care to improve health for our members and the community.
  • We hope you'll join us.
  • This senior position analyzes provider data, systems and processes to identify opportunities for improvement, data clean-up efforts and data integrity initiatives.
  • Create and analyze reports to meet the needs of the division.
  • Analyze provider data and related systems, to determine potential process or system.
  • improvements to be implemented and/or training opportunities for the team, to ensure data quality.
  • Review operational processes, procedures, quality measurements and controls for trends that affect provider data and contract payment and make recommendations as appropriate.
  • Lead process change efforts that result from the analysis.
  • Participate in the development and production of ongoing reports to meet internal and external needs, focusing on provider data quality and integrity.
  • Monitor and analyze reports and data, recommending changes as appropriate and communicating data clean-up projects as applicable.
  • Initiate system change requests to IT or vendor partner as appropriate.
  • Track and trend audit results in order to identify and correct root cause problems.
  • Recommend changes that will enhance the management and maintenance of the provider data.
  • Lead project initiatives on behalf of the division.
  • Participate in the analysis, development and implementation of projects resulting from the provider data strategy initiative.
  • Act as subject matter expert with software vendor partners.
  • Lead efforts to define the problem, building the requirements, coordinating user acceptance testing to achieve operational data quality improvements.
  • The ability to track data between key Health Managements primary systems, including Provider Web Self Service.
  • Represent Provider operations management on inter departmental workgroups.
  • Experience with the Provider Administration and Reimbursement system (PAandR) required.
  • Experience with NPI Portico Registrar, Pega, and claims processing systems Healthcare, contracting, credentialing, provider data system, NPI and HIPAA policy knowledge preferred.
  • Project coordination/Project lead skills.
  • Bachelor's degree in business or related field and at least 5 years provider related experience or at least 9 years of provider related experience in lieu of a degree.
  • Strong analytical skills including analysis, data collection, process mapping and troubleshooting for root cause.
  • The ability to lead small to large sized project groups.
  • The ability to quantify return on investment for change initiatives.
  • The ability to build positive cross divisional working relationships.
  • The ability to handle conflict situations professionally.
  • Microsoft Word, Excel and Access experience required.
  • Make a difference
  • Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity.
  • All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
  • Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
  • All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
  • Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

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