Wellmark Blue Cross Blue Shield Provider System & Database Specialist in Des Moines, Iowa
Help us lead change and transform Wellmark's business
The health care industry is changing, and Wellmark is working to help change it for the better. We recognize that our members deserve health care with a focus on quality. We also recognize that health care is complex. We’re embarking on a journey to help our members use and navigate the health care system in order to help them make clear, informed decisions, and we’re also ensuring that we take a team-centric approach when working with and in support of our members. The work that our diverse business and care teams are doing in collaboration with our health care partners will create these changes, all while working to minimize health care costs.
Use your strengths asProvider System & Database Specialist
In this role, you will work with leaders and stakeholders regarding the reporting and analysis of provider data for Network Administration and provider system functionality. This includes participation in the design, maintenance and upgrades of department provider software and databases while ensuring data integrity and accuracy. You will serve as a primary contact between internal/external stakeholdersto facilitate data and system knowledge of current and future applications, program goals and data exchanges; you will serve also as a primary contact to Wellmark Technology for facilitation of data exchange and design and for the Provider Finder solutions. In addition, you willdevelop, manage, and maintain strategic and departmental data reporting and network profiles; create reports that lead to department improved processes, workflows, data sharing and system functionality; and you will be responsible for the data management group, policies, procedures, work instructions and for ensuring a maintenance program is in place, monitored and maintained.
Ideal candidates are skilled at data management, the analysis of data, and communicating findings in a user-friendly manner. They are logical systems thinkers who understand complex information, workflows, and can spot opportunities to make continuous improvements. They enjoy supporting stakeholders with ad hoc requests and tackling data-related projects because it allows them to use their expertise while thinking critically and creatively.
Bachelor’s Degree or direct and applicable work experience
4+ years of experience:
Working with or administering databases – e.g., design, development and function; database and data extract maintenance; developing and using reports and test plans to ensure data integrity
Writing reports and complex database queries
Ability to prepare strategic and departmental dashboards for business modeling and metrics reporting
Strong verbal and written communications skills with the ability to articulate complex technical information or solutions to internal and external stakeholders
Ability to apply critical thinking skills, problem solving, and troubleshooting skills in order to:
Fulfill requests for provider information
Serve as department SME on cross-functional teams
Analyze and problem solve data gaps/discrepancies
Strong database management and data collection skills, including the ability to develop and manage department reporting systems
Proficiency with Excel, Access, Business Objects, etc.
Critical thinking skills with ability to manage multiple activities or projects
Technical aptitude to learn new data management and analysis tools quickly
Health insurance industry experience
a. Design and execute complex database queries for internal and external audiences, health networks, provider inquiries, RFI/RFPs and other operational functions, summarizing data regarding Wellmark providers and networks. Analyze data to ensure accuracy, troubleshoot for any inaccuracies and make corrections to the data or assign to the Network Administration Analysts, if necessary.b. Responsible for quality review of provider data to ensure accuracy. Develop and maintain reports to monitor data quality, tracking results and trends, and communicate results as appropriate to Quality Assurance Coaches and Network Administration leadership May provide coaching and/or mentoring to individuals within the business when frequent data anomalies are identified.c. Develop and maintain data request tools/procedures for requesting provider data and Network Administration Analyst requests for provider data system assistance. Assist analysts with data needs and questions to reduce or prevent negative production impacts, and assist with technical issues in provider data system applications.d. Apply knowledge and experience with provider and/or health management programs by leading the design, development, and maintenance of department databases, data management programs, extracts, and the provider directories.e. Serve as a contact with system vendors. Keep up-to-date and informed regarding system and vendor changes and enhancements to the credentialing database apply new information to program solutions and goals and communicate changes with staff as appropriate. Work collaboratively with the Network Administration Business Analysts and Team Leaders.f. Participate on multiple enterprise and department project initiatives, including BlueCross BlueShield Association BCBSA projects and initiatives impacting Plan provider data. Build database applications to assist the business, recognize business needs and interface with internal stakeholders. Provide oversight for completion of tasks, goals and assignments for projects.g. Assist in information gathering and sharing to internal and external audiences regarding credentialing system functionality e.g. operational, reporting metrics perspectives, interface with other systems and the data warehouse.h. Participate in the planning and recovery process for Network Administration databases, including the development of recovery plans and periodic testing exercises coordinated with Wellmark's Business Continuity Planning and response efforts.i. Develop and maintain Network Snapshot reports to summarize the composition of Wellmark's provider networks for general business intelligence. Responsible for proactively collaborating with leadership regarding the acceptance, resolution and impact on all reports and metrics regarding provider data. Actively engage with leadership on department strategic reporting and assist team leaders with understanding system capabilities for staff productivity and caseload reports.j. In collaboration with Wellmark Technology, install new updates and enhancements to the credentialing database. Design new flat or relational databases to support new Network Administration processes or reporting requirements.k. Other duties as assigned.