Manager Network Integrity - #1409761

This job was posted by https://www.kansasworks.com : For more

information, please see: https://www.kansasworks.com/jobs/13280170

Blue Cross and Blue Shield of Kansas is looking to add to our

Affordability team and has a new opportunity for a Manager, Network

Integrity. This position leads strategic initiatives to protect and

enhance the integrity of the Blue Cross Blue Shield provider network.

This role manages a team proactively identifying and mitigating

wasteful, abusive, or non-compliant billing and coding practices by

providers through the use of advanced data analytics and investigative

techniques. The Manager collaborates closely with cross-functional teams

to design and implement provider oversight programs that ensure ongoing

compliance, improve network quality, and support enterprise

affordability goals.

This position is eligible to work remotely (8 or less days a month

onsite) or hybrid (9 or more days a month onsite) in accordance with our

Telecommuting Policy. Applicants must reside in Kansas or Missouri or be

willing to relocate as a condition of employment.

• Why Join Us?**
• **Family** **Comes First**: Total rewards package that promotes the
  
  

idea of family first for all employees; including paid time off and

family first leave.

• **Professional Growth Opportunities:** Advance your career with
  
  

ongoing training and development programs both through our internal

Blue University and external opportunities.

• **Make a Positive Impact:** Your work will directly contribute to
  
  

the health and well-being of Kansans.

• **Stability:** 80 years of commitment, compassion, and community
• **Lead and Inspire:** Guide and mentor your team to achieve their
  
  

full potential and success.

**What youll do**

• Lead a team that uses data mining, statistical analysis, and
  
  

reporting tools to identify anomalies or trends in provider billing

and coding that may indicate waste, abuse, or non-compliance.

• Design and implement provider oversight programs and integrity
  
  

initiatives in collaboration with Provider Network Solutions,

Medical Management, and Special Investigations Unit.

• Develop and monitor performance dashboards, KPIs, and scorecards
  
  

related to provider billing behavior and report on trends to senior

leadership.

• Coordinate with internal stakeholders to develop corrective action
  
  

plans, education, or enforcement strategies for outlier providers.

• Lead a team tasked with conducting provider investigations to assess
  
  

provider billing practices, behaviors and patterns in claims filing

history

• Assist in development and maintenance of rules and algorithms to
  
  

flag suspicious coding patterns (e.g., upcoding, unbundling,

excessive units).

• Stay informed on regulatory and industry changes impacting coding,
  
  

billing, and network oversight practices.

• Collaborate with stakeholders across the enterprise to foster trust
  
  

and effective working relationships.