Provider Directory Data Integrity Consultant

This role is primarily responsible for supporting the integrity and accurate display of provider data in the online and print directories ensuring compliance with federal and state level guidelines and mandates, management of provider data requests, provider directory functions, and related projects. This position also plays an integral role in the creation of new functionality and networks on the provider finder tool as we launch new and modify existing networks within our portfolio. The role will support internal needs across Provider Operations and consult on corporate projects that leverage provider data. The position will leverage knowledge of core systems, data analytics, data science, and an understanding of the regulatory environment governing provider directories.

This role is eligible for our Flex persona.

Primary Activities and Responsibilities:

• Plan, organize, and direct the development, implementation, and delivery of all provider directory related applications, processes, data extracts, hardcopy directories, and Find a Doctor projects involving provider data.
• Monitor and track the production data refreshes for multiple downstream systems and processes including Find a Doctor, BPD data submission, pagination vendor extracts for hardcopy directories, data refreshes to the Connector and Change Healthcare etc.
• Participate in cross-functional workgroups established for new product launches, new provider contracting initiatives, and new or ongoing regulatory requirements, managing high level and detailed business requirements to create new data feeds and defining the business rules necessary to create new directories and new networks on the provider search tool on bluecrossma.com.
• Lead and manage the effort to design and produce the high-quality, easy-to-understand provider directories and to support other directory data and documentation needs. Respond to adhoc provider directory data requests from accounts, brokers, internal and external clients.
• Manage the stakeholders effectively and efficiently in a multi-vendor environment. Supply critical business rules, project plans, business requirements, provider data, and supplemental reference data as needed for each project. Ensure that the vendors' output in the online tool and hardcopy directories accurately reflects the data and rules provided to them.
• Performs strategic, qualitative, and quantitative analysis of the directory program for the department using research, data and analytics to resolve highly complex issues that require significant probing, analysis, and/or interpretation
• Direct NCQA, Federal and State compliance activities and development of business rules on Find a Doctor and in hardcopy directories.
• Maintain the highest standards of accuracy, quality, and consistency in provider directory data and associated disclaimers, descriptions, and collateral material.
• Work cross-functionally to produce material that meets our corporate, ACA, BCBSA, CMS, DOI, NCQA, and brand requirements and standards.
• Plan, coordinate, and facilitate cross-functional program or project team meetings ensuring full participation of all impacted areas including internal and external stakeholders.
• Track, document, and report status to key leaders and other managers as appropriate.
• Identify, mitigate/ resolve, escalate risks and issues while taking accountability for decisions. Works to ensure continuous improvement and adoption of data management best practices

Knowledge and Skills

• In-depth knowledge of health insurance systems and the provider business area
• Excellent data analytical and visualization skills using SAS, Tableau etc.
• Experience with various data management and ETL tools like Netezza, Informatica, etc.
• Strong computer skills - Database management, Data Warehouse, MS Access, Visio
• Strong organizational, interpersonal, and communication skills
• Ability to prioritize, handle multiple tasks and projects within a fast-paced environment
• Ability to effectively plan, facilitate and record multi-disciplinary meetings and workgroups
• Looking for the following attributes: logical thinker, organized, detail-oriented, high energy, creativity, good business acumen, positive attitude, and deadline driven professional
• Ability to work in a dynamic and changing environment and works well independently and as a member of team
• Demonstrated experience in leading all aspects of project life cycle, such as: business case development, communication plan development, work plan development and maintenance, resource planning, status reporting, issue/risk identification and management, performance measurement

Experience and Education

• BS/BA degree preferred or equivalent work experience in healthcare, health management, or related fields
• 8-10 years of experience in healthcare industry or other relevant experience

High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.