Credentialing Business Analyst

Blue Cross and Blue Shield of Kansas City
parental leave, paid time off, paid holidays, tuition reimbursement, 401(k), employee discount
United States, Missouri, Kansas City
2301 Main Street (Show on map)
Dec 14, 2024
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 Credentialing Business Analyst formulates and defines systems scope and objectives; and combines an understanding of applicable business systems and industry requirements. The analyst utilizes their knowledge of software programs and business acumen to provide detailed analysis of complex business problems. This individual will anticipate business needs and develop solutions to improve processes and functionality for our business. The analyst will also provide end user support for applications and their interfaces collaborating between Provider Contracting, Provider Reimbursement, Provider Demographics, IT, Operations, and other related business teams, understanding regulatory mandates, Blue KC's credentialing policies and procedures, providers lifecycle, and provider application capabilities. This role performs with minimal supervision. Job Description Assists in designing, documenting, and evaluating information system solutions, considering functionality, data, security, integration, infrastructure, and performance. Work with team members to develop and administer the processes and procedures associated with implementing and introducing modifications in provider system software, system configuration or system procedures. Serves as a subject matter expert (SME) for provider management platform application by examining product documentation, system configuration, and available training materials. Ability to develop and coordinate credentialing policy and procedures into system workflows and capabilities. Determines appropriate information to be loaded into the system and enters information to maintain functionality of the system. Monitors the day-to-day production and test environments to ensure that the system is performing as expected and being used effectively and efficiently to support the business. Identifies errors and determines source of problems and necessary corrective actions. Researches and analyzes support issues; determines corrective action, prepares detailed documentation for "fix" and, where necessary, refers to appropriate person for coding or programming modifications. Communicates corrections and new procedures (if applicable) to all stakeholders. Minimum Qualifications: Bachelor's degree or equivalent combination of education and experience required 5 years of relevant experience in business analysis in healthcare required Proven experience in problem definition, data collection to establish facts, and drawing valid conclusions to solve practical problems while working with a variety of concrete variables in situations where only limited standardization and direction exists. Working knowledge of medical terminology, healthcare workflows, industry regulatory bodies (CMS, NCQA, BCBSA, etc), operational systems, internet application concepts Proficient with Microsoft Office software Preferred Qualifications: Previous experience with credentialing and quality accreditation for a payer Previous experience with sPayer 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.