Provider Specialist
The Provider Specialist is responsible for troubleshooting issues, providing detailed information related to claims, coverage, and benefit plans, and ensuring provider concerns are resolved in a timely and efficient manner.
Key responsibilities include verifying provider credentialing for suspended claims; verifying professional and facility pricing; maintaining thorough and accurate documentation of all inquiries within designated tracking systems; and applying a working knowledge of provider support systems. The role supports providers across the Federal Employee Program (FEP); Local and Commercial PA and AHNJ plans; BlueCard; and Government markets.
Additionally, the position requires participation in special projects and work groups as assigned, as well as collaboration with internal teams to improve provider service processes. Other duties may be assigned as needed to support departmental and organizational goals.
Bachelor’s degree in business, Health Care, or a related field/commensurate work experience. In lieu of a BS/BA degree, extensive experience and knowledge of (3-5 years) IBC’s various operating systems is acceptable. In-depth knowledge of managed care and professional payment systems is preferred. A demonstrated knowledge of various operational departments including Claims, Medical Policy, Contracting, Specialty Programs, Benefits, and Network Services is preferred. The ideal candidate will be self-motivated, highly organized, detail-oriented, able to handle multiple high priorities, as well as possess above average problem solving, analytical and communication skills (both written and verbal). An established ability to interact with all levels of management is required. Proficiency with Excel and Access are required. Proficiency with Project is preferred.
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.