Provider Partnership Associate

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

The Provider Network Services Provider Partnership Associatesupports 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 health-care-related 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 multi-media approach to small and large groups.

Prior experience in a service-oriented role strongly preferred.

The candidate must be self-motivated with strong interpersonal, analytical, problem-solving, 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.

Inclusion and Belonging

At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

About Our Company

Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.

At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com . We’re revolutionizing health care, and our focus is on you!

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.