Healthcare Partnership Associate
2 weeks ago
We are seeking a dynamic and detail-oriented Provider Partnership Associate to join our team at Independence Blue Cross. This role will support our Integrated Delivery Health Systems (IDS) and community providers in Pennsylvania and Delaware.
Key Responsibilities- Independently researches, analyzes, and addresses provider issues and concerns to achieve expected goals/outcomes within 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 of 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.
- Bachelor's degree or equivalent work experience.
- Minimum five years progressive experience in a healthcare-related organization, with experience in Provider Networks, Contracting, Claims Processing, or Managed Care Operations strongly preferred.
- Knowledge of professional billing requirements, reimbursement methodology, IBC/AmeriHealth products, medical policy, and benefits.
- Proficiency with Word, Excel, Access, and Outlook.
- Experience using multiple IBC systems, PEAR, and the suite of Highmark applications, including INSINQ, OCWA, OSCAR, 4UM, 310 Database, Provider Profiles, and PGRS.
- Proven ability to conduct educational programs using a multi-media approach to small and large groups.
- Prior experience in a service-oriented role strongly preferred.
- Self-motivated with strong interpersonal, analytical, problem-solving, organizational, time management, and written and verbal communication skills.
- Ability to independently manage multiple priorities with varying levels of complexity and customer expectations to a successful conclusion with limited supervision.
This role is designated as a hybrid model, which consists of working in the office 3 days a week (Tuesday, Wednesday, and Thursday) and remotely 2 days a week (Monday and Friday). The work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
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