Provider Network Operations Specialist

Supports provider network operations for Blue Cross Blue Shield of Kansas by managing end-to-end provider enrollment and maintenance processes. Performs intake, screening, eligibility review, and timely processing of applications, changes, and terminations while maintaining accurate provider records within Provider Network Solutions systems. Coordinates onboarding with Provider Representatives and tracks contract participation across network offerings. Serves as a resource for providers and internal stakeholders on enrollment and participation guidelines.

“This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

What you’ll do

• Supports provider network operations by managing intake, enrollment, and ongoing maintenance of provider records.
• Serves as the initial point of contact for enrollment and maintenance submissions, assigning workflows and responding to provider inquiries to initiate onboarding.
• Conducts eligibility research and validation in accordance with Centers for Medicare & Medicaid Services, federal and state regulations, accreditation standards, and organizational requirements.
• Executes the full enrollment lifecycle, including application review, verification of licensure, accreditation, NPI registration, and board certification, as well as record creation and onboarding coordination.
• Maintains accurate provider records across network management systems, processing updates, changes, and terminations in alignment with compliance standards.
• Leads provider data accuracy efforts by performing outreach, resolving discrepancies, and documenting updates to meet regulatory and business requirements.
• Conducts audits, supports reporting and audit activities, and contributes to ongoing data accuracy initiatives and project plans.
• Provides guidance to providers and internal stakeholders on enrollment processes, network participation, and the importance of maintaining accurate provider data, including use of self-service tools for validation.

• Must be able to learn and apply network contracting knowledge throughout enrollment processing for BCBSKS owned and serviced contracts.
• Ability to work well with multiple active work items and adhere to both complimentary and competing service level agreements.
• Ability to communicate effectively and professionally with staff from provider offices, physicians, and all levels of internal staff required.
• Employ independent and procedural thinking skills to complete records within defined data entry systems.
• Understand sequential workflow procedures.
• Work with high degree of accuracy to complete record update processing within defined quality and compliance standards.
• Proficiency in utilizing a personal computer is required with knowledge of Microsoft Office suite products.
• Proficiency with operating systems and standard business software
• Demonstrated verbal and written communication and human relation skills with the ability to interact positively at all levels with internal and external peers.

Education and Experience:

• High school graduate or equivalent is required.
• Education or experience in communications, human relations, medical terminology, or contract compliance preferred.
• Minimum two years of experience BCBSKS operational experience to include customer service, claims or membership OR 3 years demonstrated experience working with medical insurance is required.

Physical Requirements:

• Some lifting of moderately heavy items up to 15 pounds relative to any printed procedure or training manuals.
• Position will be PC work up to 90% of the day to include keying, electronic communications, and virtual meeting attendance; phone usage up to 75% of the day.
• For onsite position assignment, sit / stand desk is available.
• For candidates eligible for work from home or hybrid telecommuting status, onsite attendance at our main campus can be requested as a condition of this position at any time. Must be able to travel as requested.

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
• Professional Growth Opportunities: Advance your career with ongoing training and development programs.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
• Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
• Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.

Benefits & Perks

• Base compensation is only one component of your competitive Total Rewards package
• Incentive pay program (EPIP)
• Health/Vision/Dental insurance
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks paid caregiver leave
• 401(k) plan matching up to 5%
• Tuition reimbursement

• Health & fitness benefits, discounts and resources, $23.58 - $29.40 hourly Non - Exempt Grade 12

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual’s skills, education, experience, and training. The range may vary above or below the stated amounts.

Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.