Senior Provider Network Partnerships Specialist

Independence Blue Cross; Philadelphia (Philadelphia County); Sur place; USD 70 000 - 110 000; Plein temps

Résumé du poste

Independence Blue Cross is seeking a Senior Provider Partnership Associate to support IDS and a broad provider network across PA and DE. You will research and address provider issues, educate on policy changes, and maintain strong relationships to improve provider satisfaction.

The role requires a bachelor’s degree or equivalent and at least five years in a healthcare setting, with expertise in claims, contracting, or managed care operations.

Qualifications

• Bachelor’s degree or equivalent work experience.
• Minimum five years’ progressive experience in a health-care related organization, 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 Outlook, Word, Access, and Excel (including pivot tables, filters, and formulas).
• Experience using multiple IBC systems and the suite of enGen applications including but not limited to: INSINQ, OCWA, OSCAR, HRP, Aerial, OneHub, 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.

Responsabilités

• Supports IDS and community providers in Pennsylvania and Delaware.
• Researches and addresses provider issues to achieve goals within set timeframes.
• Educates providers on new initiatives and policy changes affecting claims payments.
• Establishes and maintains professional relationships between IBX and network providers to improve provider satisfaction.
• Resolves issues related to complex claims payments, provider data file maintenance, Quality Incentive Payments (QIPS), capitation, and medical policy.
• Maintains and updates the tracking issues database with current statuses and next steps.
• Collaborates with other departments to assist with resolution of complex provider issues.

Connaissances

Interpersonal skills

Analytical thinking

Problem-solving

Organizational skills

Time management

Written and verbal communications

Customer service

Multitasking

Formation

Bachelor’s degree or equivalent work experience

Outils

Outlook

Word

Access

Excel

Description du poste

Independence Blue Cross is seeking a Senior Provider Partnership Associate to support IDS and a broad provider network across PA and DE. You will research and address provider issues, educate on policy changes, and maintain strong relationships to improve provider satisfaction.

The role requires a bachelor’s degree or equivalent and at least five years in a healthcare setting, with expertise in claims, contracting, or managed care operations.