Provider Partnership Associate

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

Job summary

Independence Blue Cross, LLC is seeking a Provider Partnership Associate (Finance) to support IDS and network providers across Pennsylvania and Delaware. The role involves researching provider issues, educating on policy changes affecting claims payments, and maintaining strong provider relationships to improve satisfaction.

The candidate should have a bachelor's degree or equivalent experience and at least five years in a healthcare-related organization, with experience in provider networks,

Qualifications

• Bachelor's degree or equivalent work experience.
• Minimum five years' progressive experience in a healthcare-related organization.
• 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 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 service-oriented role strongly preferred.
• Self-motivated 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.

Responsibilities

• Researches, analyzes, and addresses provider issues and concerns to meet goals within timeframes.
• Educates providers on new initiatives and policy changes affecting claims payments.
• Establishes and maintains professional relationships between IBC and network providers to improve provider satisfaction.
• Resolves issues related to complex claims payments, provider data file 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

Interpersonal skills

Analytical thinking

Problem solving

Organizational skills

Time management

Written and verbal communication

Education

Bachelor's degree

Tools

Navinet

IBC software suite

Job description

Provider Partnership Associate (Finance)

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.