Senior Provider Partnership Associate

Independence Blue Cross; Philadelphia (Philadelphia County); On-site; USD 70,000 - 110,000; Full time

Job summary

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.

Responsibilities

• 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.

Skills

Interpersonal skills

Analytical thinking

Problem-solving

Organizational skills

Time management

Written and verbal communications

Customer service

Multitasking

Education

Bachelor’s degree or equivalent work experience

Tools

Outlook

Word

Access

Excel

Job description

The Provider Network ServicesSenior 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.

1. The candidate must have a bachelor’s degree or equivalent work experience.

2. 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.

3. Knowledge of professional billing requirements, reimbursement methodology, IBC/AmeriHealth products, medical policy, and benefits.

4. Proficiency with Outlook, Word, Access, and Excel (including pivot tables, filters, and formulas).

5. 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.

6. Proven ability to conduct educational programs using a multi-media approach to small and large groups.

7. Prior experience in a service-oriented role strongly preferred.

8. The candidate must be self-motivated with strong interpersonal, analytical, problem-solving, organizational, time management, and written and verbal communications skills.

9. 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.

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.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

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.

Agency Disclaimer

All resumes submitted directly to anIndependence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross andthe Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross orthe Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.

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