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Operations
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240612 Requisition #

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.

This role prices professional, ancillary, and institutional claims for In Network, Out of Network and leased/rental network provider claims.  Pricing is applied to incoming claims including adjustments, out of network, custom rates and schedule/contract % provider type contracts.  This position ensures timely and accurately pricing of all claim types including adjustments, QA, Performance Guarantees and/MTM audits, email inquiries.  Research complex requests to verify original claim pricing. Interpret and apply contract terms to claims/adjustments and high dollar claims.  Collaborates with Provider Relations team to identify/locate fee tables and complex contract requirements.  Works independently utilizing system resources and pricing tools. 

·        2 years' related experience, claim processing, provider billing or familiarity with provider contracting

·        Some college a plus

·        Excellent mathematical skills, demonstrated proficiency in math

·        Strong computer proficiency with Microsoft Office including excel

·        Excellent critical thinking and problem-solving skills

·        Excellent verbal and written communication skills

Hybrid of Choice:

Independence has implemented a “Hybrid of Choice” model which provides our associates with the flexibility to choose whether to work remotely, work in the office every day, or work in the office on certain days at their discretion. However, management may require our associates to work from Independence’s physical office locations on certain occasions. This role is designated as a role that fits into the “Hybrid of Choice” model. While associates may work remotely, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania.

 

Diversity, Equity, and Inclusion

At AmeriHealth, everyone can feel valued, supported, and comfortable to be themselves.  Our commitment to equity means that all associates have a fair opportunity to achieve their full potential.  We put these principles into action every day by acting with integrity and respect.  We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace.  Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

About Our Company

Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.

 

At AmeriHealth, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations.  For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!

 

 

Equal Employment Opportunity

AmeriHealth is an Equal Opportunity and Affirmative Action 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. 

Agency Disclaimer

All resumes submitted directly to an AmeriHealth employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of AmeriHealth and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by AmeriHealth or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.

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