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Independence Blue Cross · 2 days ago

Sr Provider Partnership Assoc

Philadelphia, Pennsylvania

Full-time

Onsite

Senior Level

5+ years exp

Independence Blue Cross is seeking a Senior Provider Partnership Associate to support Integrated Delivery Health Systems and community providers in Pennsylvania and Delaware. This role involves addressing provider issues, educating them on new initiatives, and maintaining effective relationships to improve provider satisfaction.

Health CareHealth InsuranceInsuranceMedical

Responsibilities

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

Qualification

Provider NetworksClaims ProcessingManaged Care OperationsProfessional BillingReimbursement MethodologyMicrosoft ExcelEnGen ApplicationsAnalytical SkillsInterpersonal SkillsProblem-Solving SkillsOrganizational SkillsTime ManagementWritten CommunicationVerbal Communication

Required

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 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

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 is essential, as is the ability to interact effectively with all levels of management, including medical directors

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