Provider Systems Business Analyst, Senior

Blue Cross and Blue Shield of Kansas City is dedicated to providing health, financial, and lifestyle benefits for a best-in-class employee experience. The Senior Provider Business Analyst plays a critical role in advancing strategies and operations that support provider credentialing and lifecycle management, serving as a subject matter expert and driving cross-functional initiatives to align provider processes with enterprise goals and regulatory requirements.

Responsibilities:

• Lead and oversee large project implementations and upgrades of provider management platforms, ensuring seamless integration and alignment with organizational goals
• Manage Business Data Governance Committee to instill data standards and accuracy
• Serve as a subject matter expert (SME) on provider management platforms, credentialing/contracting/directory data/provider relations workflows, and regulatory standards
• Collaborate with cross-functional teams to design and implement scalable solutions that improve provider onboarding, data integrity, and operational efficiency
• Manage vendors to adhere to SLA and performance measures to ensure compliance
• Apply strong analytical and problem-solving skills to identify, analyze, and resolve complex business issues related to provider management
• Monitor production and test environments, proactively identifying and resolving issues to ensure optimal system performance
• Write efficient, insightful reports utilizing SQL to inform decision-making and monitor key performance indicators
• Mentor junior analysts and contribute to the development of department policies, procedures, and training materials
• Drive continuous improvement initiatives by leveraging data insights, stakeholder feedback, and industry trends
• Support NCQA or URAC Accreditation efforts by maintaining high standards for provider network, data, and credentialing

Requirements:

• Bachelor's degree or an equivalent combination of education and experience
• 5+ years of experience in business analysis within a payer, with a focus on credentialing and provider data management
• Expert with sPayer or other payer provider lifecycle/credentialing/contracting systems, CRM, and quality accreditation processes
• Efficient report writer utilizing SQL
• Experience maintaining NCQA or URAC accreditation
• Proven ability to lead cross-functional initiatives and influence stakeholders at all levels
• Strong analytical, problem-solving, and communication skills
• Large project implementation or upgrade of provider management platforms
• Proficiency in Microsoft Office applications
• Master's Degree in Information Systems, Data Management, Healthcare Administration or a related academic field
• Experience with Facets Claims software