Provider Systems Business Analyst, Senior
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 Senior Provider Business Analyst plays a critical leadership role in advancing the strategy, systems, and operations that support provider credentialing, contracting, and lifecycle management. This individual serves as a trusted advisor and subject matter expert, driving cross-functional initiatives that align provider processes with enterprise goals, regulatory requirements, and industry best practices. With a deep understanding of healthcare/payer operations, credentialing standards (e.g., NCQA, CMS, BCBSA), and provider data systems, the Senior Analyst leads the design and optimization of workflows, system configurations, and data governance strategies. This role partners closely with Provider Contracting, Reimbursement, IT, Compliance, and vendors to ensure provider lifecycle systems are scalable, compliant, and efficient.Job Description
- 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.
Minimum Qualifications
- 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.
Preferred Qualifications
- Master’s Degree in Information Systems, Data Management, Healthcare Administration or a related academic field
- Experience with Facets Claims software
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.
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