Provider Partnership Associate
The Provider Partnership Associate (PPA) will cultivate and maintain relationships with and provide service to institutional and/or professional providers. Institutional providers include all hospitals, hospital systems, and ancillaries. Professional providers include primary care physicians, specialist physicians, and all other credentialed health care professionals. Either an institutional or professional provider may also include the understanding and maintenance of alternative payment arrangements, such as ACOs. Independently researches, analyzes, and addresses provider issues and concerns to achieve expected goals/outcomes within the set timeframes. The PPA will be proactive in providing comprehensive education on new products and networks, instruction on clinical initiatives (ACOs, etc.) and other quality programs, and resolution on matters involving claims and/or payments.
Responsibilities:
- 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.
- Attends onsite, face-to-face, or virtual visits with all provider types and administrators when necessary to communicate changes and provide issue resolution that assists participating providers in the efficient administration of our benefit plans.
- Develops and delivers provider education and issue resolution in pursuit of network strategies (product portfolio and product changes, payment policy changes, reimbursement methodologies, PEAR/other provider tools, clinical initiatives, etc.).
- Ensures that key goals and objectives are accomplished in keeping with established priorities and timeframes.
- Works with Network Operations, or other areas at AmeriHealth New Jersey to identify and resolve provider issues.
- Establishes and maintains professional and effective relationships with practice administrators, medical directors, and practitioners to ensure compliance with contractual obligations, applicable State & Federal regulatory requirements, accreditation standards, and corporate policies.
- Provides claims issue resolution from identification/root cause of the problem through the communication of outcome to the provider.
- Facilitates provider demographic changes with Provider Data Administration.
- Addresses provider issues using the required ticket and inquiry tracking system processes.
- Discusses and proposes recommendations to management to support provider engagement strategies and overall provider experience.
- Completes assigned projects to support corporate initiatives within the timeframe set by management.
- Supports other members of the team to ensure that service levels and goals are met.
- Performs other duties as assigned.
Education
Bachelor’s degree preferred.
Experience
3-5 years of provider relations, or managed care contracting experience. Claims processing, customer service, and/or managed care experience preferred.
Skill Sets
- Proficient in Microsoft Office Suite.
- Excellent oral and written communication skills.
- Ability to work independently and within a team.
- Current state driver’s license.
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 Cranbury, New Jersey area.
Diversity, Equity, and Inclusion
At Independence, 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 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
Independence Blue Cross 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 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.