Manager Provider Network Services
The Manager, Provider Network Services is accountable for creating, implementing, and maintaining an effective model for servicing (external facing and via provider portal) professional, hospital, ancillary and specialty care providers and integrated delivery systems in Pennsylvania and Delaware.
MAJOR ACTIVITIES:
1. Manages the relationships between Independence/AmeriHealth and providers’ practice administrators, medical directors, and health system administrators to ensure high-quality, provider satisfaction and compliance with contractual obligations, applicable State & Federal regulatory requirements, accreditation standards, and corporate policies.
2. Recruits, retains, allocates and develops staff and create positive working relationships with functional areas, providers, and other external customers/stakeholders.
3. Manages service issues tracking and reporting.
4. Performs analysis of data and trends.
5. Supports and monitors resolution of issues that impact providers, including but not limited to issues regarding claim payments, pricing/reimbursement, provider data file discrepancies, credentialing, Quality Incentive Payments (QIPS), capitation, medical policy, utilization management, cost containment and other compliance initiatives.
6. Uses the information gained during servicing activities to identify and support the identification of significant opportunities to improve operational efficiency, reduce costs and improve provider satisfaction.
7. Works collaboratively with other business areas to improve performance, productivity, efficiency, process, and service response across the organization.
8. Acts as the relationship manager to strategically partner providers with Independence/ AmeriHealth on corporate-wide strategic initiatives and improve the provider experience and overall satisfaction.
9. Supports the development of provider educational materials and reinforces written provider communications relative to new initiatives and changes in medical and claims payment policy and related operational procedures.
Education
Bachelor’s degree in Business, Health Administration or a related field/equivalent experience required.
Master’s degree preferred.
Experience
Minimum of 5 years progressive experience in a managed care setting required. 5 years progressive supervisory/management experience in managed care preferred. Prior experience working with hospital systems and other facility and ancillary provider types at a management level in Provider Servicing, Provider Contracting or Claims Processing strongly preferred.
Skills & Abilities
1. Excellent analytical, problem-solving, and organizational skills.
2. Excellent written and verbal communication, and interpersonal skills required.
3. Demonstrated leadership experience.
4. Demonstrated ability to manage independently and effectively multiple, competing priorities and projects.
5. Demonstrated experience with MS Office Suite.
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 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 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.