Provider Partnership Associate at Independence Blue Cross LLC in Philadelphia, Pennsylvania

Job Description:

Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals.  If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.

 

The 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 of 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

 

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


• 
  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 are strongly preferred.
  


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


• 
  Proficiency with Word, Excel, Access, and Outlook.
  


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  Experience using multiple IBC systems, PEAR, 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 multi-media approach to small and large groups.
  


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


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


• 
  The 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.
  

 

 

Hybrid:

Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.

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