Provider Partnership Associate
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
- 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.
- 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.
- 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.
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.