Provider Relations Specialist

2 weeks ago

Cranbury, New Jersey, United States Independence Blue Cross Full time

About the Role:
As a key member of the Provider Network Services team, the Provider Partnership Associate plays a crucial role in supporting ancillary and institutional providers across the state. This position is designed for individuals who thrive in a collaborative environment and are committed to enhancing provider satisfaction and operational efficiency.

Key Responsibilities:

  • Independently assist health systems and ancillary providers, ensuring they are well-informed about new initiatives and policy changes affecting claims payments.
  • Achieve established goals and objectives while adhering to prioritized timelines.
  • Conduct thorough research and analysis on provider-related issues, ensuring timely resolution of concerns.
  • Maintain an up-to-date tracking database to monitor issues and next steps.
  • Perform root cause analysis and collaborate with various departments to resolve complex provider issues effectively.
  • Utilize insights gained from service interactions to recommend improvements in operational processes and provider satisfaction.
  • Build and sustain professional relationships with practice administrators, medical directors, and practitioners to ensure compliance with contractual and regulatory standards.
  • Engage with management to identify and resolve policy and procedural challenges.
  • Complete assigned projects that align with corporate initiatives within designated timeframes.
  • Support team members to meet service levels and organizational goals.
  • Perform additional duties as required.

Qualifications:

  • A bachelor’s degree or equivalent experience is required.
  • At least five years of progressive experience in a healthcare-related organization, with a preference for experience in Provider Networks, Contracting, Claims Processing, or Managed Care Operations.
  • Familiarity with institutional billing requirements and reimbursement methodologies.
  • Proficient in Microsoft Outlook, Word, Access, and Excel, including advanced functions.
  • Experience navigating multiple systems for claims adjudication and contract management.
  • Demonstrated ability to conduct educational sessions for diverse audiences.
  • Previous experience in a customer service-oriented role is preferred.
  • Strong interpersonal, analytical, problem-solving, organizational, and communication skills are essential.
  • Ability to manage multiple priorities independently while effectively engaging with all levels of management.

Work Environment:
This position follows a hybrid work model, requiring in-office attendance three days a week and remote work for two days. It is essential for candidates to be located in the designated area to fulfill the role's requirements.

Equal Opportunity Employer:
Independence Blue Cross is committed to fostering a diverse and inclusive workplace. All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

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