Provider Partnership Assoc
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- Provider Network Services
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- 1 day ago Post Date
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- 260372 Requisition #
Provider Partnership Assoc - (260138) Description 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.
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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, 4UM, 310 Database, 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.
IBX is an Equal Opportunity 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.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
Inclusion and Belonging
At IBX, everyone can feel valued, supported, and comfortable to be themselves, and 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. Celebrating and embracing 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 nearly 10 million people in 25 states and the District of Columbia, including 2.5 million in southeastern Pennsylvania, Independence Health Group is the leading health insurance company in the Philadelphia region, and we’re expanding across the country. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, 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
IBX is an Equal Opportunity 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 Independence Blue Cross 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 Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.