Provider Network Partnerships Specialist

Independence Blue Cross; Philadelphia (Philadelphia County); On-site; USD 70,000 - 100,000; Full time

Job summary

Independence Blue Cross is seeking a Provider Network Services Partnership Associate to support Integrated Delivery Health Systems and a broad network of providers across Pennsylvania and Delaware.

The role involves researching provider issues, educating on new initiatives, and fostering strong relationships to improve provider satisfaction while handling complex claims, data, and policy processes with limited supervision.

Qualifications

• Bachelor’s degree or equivalent work experience.
• Minimum five years’ progressive experience in a health-care-related organization.
• Experience in Provider Networks, Contracting, Claims Processing or Managed Care Operations strongly preferred.
• Knowledge of professional billing requirements, reimbursement methodology, medical policy, and benefits.
• Proficiency with Word, Excel, Access, and Outlook.
• Experience using Navinet and Highmark applications (INSINQ, OCWA, OSCAR, 4UM, 310 Database, Provider Profiles, and PGRS).
• Proven ability to conduct educational programs using a multi-media approach.
• Prior service-oriented experience preferred.
• Strong interpersonal, analytical, problem-solving, organizational, time management, and written/verbal communication skills.

Responsibilities

• Independently researches, analyzes, and addresses provider issues to meet goals within timeframes.
• Educates providers on new initiatives and policy changes affecting claims payments; outreach for UM Vendor Management Programs.
• Establishes and maintains professional relationships between IBC and network providers to improve satisfaction.
• Resolves issues related to complex claims payment, provider data maintenance, QIPS, capitation, and medical policy.
• Maintains and updates tracking issues database with current statuses and next steps.
• Collaborates with other departments to resolve complex provider issues.

Skills

Provider networks

Educational programs

Interpersonal skills

Analytical skills

Problem-solving

Time management

Written & verbal communication

Multitasking

Education

Bachelor's degree or equivalent

Tools

Navinet

INSINQ

OCWA

OSCAR

4UM

310 Database

Provider Profiles

PGRS

Highmark applications

Job description

Independence Blue Cross is seeking a Provider Network Services Partnership Associate to support Integrated Delivery Health Systems and a broad network of providers across Pennsylvania and Delaware.

The role involves researching provider issues, educating on new initiatives, and fostering strong relationships to improve provider satisfaction while handling complex claims, data, and policy processes with limited supervision.