Senior Provider Partnership Associate

Independence Blue Cross, LLC; Philadelphia (Philadelphia County); On-site; USD 65,000 - 90,000; Full time

Job summary

Independence Blue Cross, LLC in Philadelphia seeks a Senior Provider Partnership Associate to support IDS and community providers in PA and DE. You will independently research, analyze, and address provider issues to achieve goals within set timeframes and educate providers on new initiatives impacting claims payments.

The role requires building professional relationships with IBC networks, resolving complex payment and policy questions, maintaining data files, and collaborating with other

Qualifications

• Bachelor's degree or equivalent work experience.
• Minimum five years' progressive healthcare experience, with provider networks/claims preferred.
• Knowledge of professional billing, reimbursement methods, and medical policy.
• Proficiency with Outlook, Word, Access, and Excel (pivot tables, filters, formulas).
• Experience with enGen applications: INSINQ, OCWA, OSCAR, HRP, Aerial, OneHub, Provider Profiles, PGRS.
• Ability to conduct educational programs for small and large groups.
• Prior service-oriented experience preferred.
• Self-motivated with strong interpersonal, analytical, problem-solving, organizational and communication skills.
• Ability to manage multiple priorities with limited supervision and interact with all management levels.

Responsibilities

• Researches and analyzes provider issues to meet goals within timeframes.
• Educates providers on new 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 current with statuses and next steps.
• Collaborates with other departments to resolve complex provider issues.

Skills

Analytical skills

Interpersonal skills

Written and verbal communication

Time management

Education coordination

Education

Bachelor's degree or equivalent experience

Tools

Excel

Pivot tables

Outlook

Access

OneHub

INSINQ

OCWA

OSCAR

HRP

Aerial

PGRS

Job description

The Provider Network Services Senior 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. 1. The candidate must have a bachelor's degree or equivalent work experience.
2. 2. Minimum five years' progressive experience in a healthcare related organization is required, with experience in Provider Networks, Contracting, Claims Processing or Managed Care Operations strongly preferred.
3. 3. Knowledge of professional billing requirements, reimbursement methodology, IBC/AmeriHealth products, medical policy, and benefits.
4. 4. Proficiency with Outlook, Word, Access, and Excel (including pivot tables, filters, and formulas).
5. 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. 6. Proven ability to conduct educational programs using a multimedia approach to small and large groups.
7. 7. Prior experience in a serviceoriented role strongly preferred.
8. 8. The candidate must be selfmotivated with strong interpersonal, analytical, problemsolving, organizational, time management, and written and verbal communications skills.
9. 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.