Senior Provider Relations & Network Partnerships Lead

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

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