Provider Partnership Associate

Independence Blue Cross, LLC; Philadelphia (Philadelphia County); On-site; USD 80,000 - 95,000; Full time

Job summary

Independence Blue Cross, LLC seeks a Provider Network Services Partnership Associate to support IDS and community providers across Pennsylvania and Delaware. The role involves researching provider issues and educating on policy changes affecting claims payments, while building strong relationships to improve provider satisfaction.

The candidate should have a bachelor’s degree or equivalent experience and at least five years in a healthcare-related organization, with knowledge of billing,

Qualifications

• Bachelor's degree or equivalent work experience.
• Minimum five years' progressive healthcare experience.
• Knowledge of professional billing, reimbursement, and health plan policies.

Responsibilities

• Researches and addresses provider issues to meet goals within timeframes.
• Educates providers on initiatives and policy changes affecting claims payments.
• Maintains professional relationships between IBC and network providers to improve satisfaction.
• Resolves complex issues related to claims payments, data maintenance, QIPS, capitation, and medical policy.
• Keeps tracking issues database updated with statuses and next steps.
• Collaborates with other departments to resolve provider issues.

Skills

Interpersonal skills

Analytical

Problem solving

Time management

Written communication

Verbal communication

multitasking

Education

Bachelor's degree or equivalent

Tools

Navinet

INSINQ

OCWA

OSCAR

4UM

PGRS

Job description

The Provider Network Services Provider Partnership Associate supports Integrated Delivery Health Systems (IDS) and community providers including but not limited to primary care physicians, specialists, ancillary, behavioral health, and institutional providers in Pennsylvania and Delaware.

• Independently researches, analyzes, and addresses provider issues and concerns to achieve expected goals/outcomes within the set timeframes.
• Proactively educates providers on new initiatives and policy changes that impact their claims payments, including outreach for UM Vendor Management Programs.
• Establishes and maintains professional and effective relationships between IBC and network providers to continually improve provider satisfaction.
• Ensures the resolution to issues related to complex claims payment, provider data file maintenance, Quality Incentive Payments (QIPS), capitation, and medical policy.
• Maintains and updates the appropriate tracking issues database with current statuses and next steps.
• Collaborates with other departments within the organization to assist with resolution of complex provider issues.

Qualifications

• The candidate must have a bachelor\'s degree or equivalent work experience.
• Minimum five years\' progressive experience in a healthcarerelated organization is required, with experience in Provider Networks, Contracting, Claims Processing or Managed Care Operations strongly preferred.
• Knowledge of professional billing requirements, reimbursement methodology, IBC/AmeriHealth products, medical policy, and benefits.
• Proficiency with Word, Excel, Access, and Outlook.
• Experience using multiple IBC systems, Navinet, and the suite of Highmark applications including but not limited to: INSINQ, OCWA, OSCAR, 4UM, 310 Database, Provider Profiles, and PGRS.
• Proven ability to conduct educational programs using a multimedia approach to small and large groups.
• Prior experience in a serviceoriented role strongly preferred.
• The candidate must be selfmotivated with strong interpersonal, analytical, problemsolving, organizational, time management, and written and verbal communications skills.
• Ability to independently manage multiple priorities with varying levels of complexity and customer expectations to a successful conclusion with limited supervision is essential, as is the ability to interact effectively with all levels of management, including medical directors.