Provider Partnership Associate (Healthcare)
Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.
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 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.
MAJOR ACTIVITIES:
1. Independently supports health systems and services community providers, including but not limited to primary care physicians, specialists, ancillary, behavioral health, and institutional providers. Educates providers concerning new initiatives and policy changes that impact their claims payments.
2. Handles Provider Validation Roster requests within established timeframes. Ensures completion/submission of all necessary change forms to support the Provider Roster Validation process.
3. Ensures that key goals and objectives are accomplished in keeping with established priorities and timeframes.
4. Performs research and analysis of all provider issues received both externally and internally. Addresses provider issues and concerns to ensure that expected goals/outcomes are achieved within the set timeframes.
5. Maintains and updates the appropriate tracking issues database with current statuses and next steps.
6. Conducts root cause analysis and works collaboratively with staff in other business areas to assist with the resolution of complex provider issues and achieve expected goals/outcomes within established timeframes, requesting the support of management when needed.
7. Uses the information gained during servicing activities to make recommendations to management regarding the identification of significant opportunities to improve operational efficiency, reduce costs and improve provider satisfaction.
8. Establishes and maintains professional and effective relationships between IBC and practice administrators, medical directors, and practitioners to ensure compliance with contractual obligations, applicable State & Federal regulatory requirements, accreditation standards, and corporate policies.
9. Develops and maintains professional and effective relationships with various levels of management within IBC to achieve successful outcomes. Identifies policies and procedural issues and recommends potential resolutions by working with management.
10. Completes assigned projects to support corporate initiatives within the timeframe set by Management.
11. Supports other members of the team to ensure that service levels and goals are met.
12.Performs other duties as assigned.
Qualifications:
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.
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
Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to
