Provider Partnership Associate

The Provider Network Services Provider Partnership Associatesupports Integrated Delivery Health Systems (IDS) and community providers including but not limited to primary care physicians, specialists, ancillary, behavioral health, and institutional providers in Pennsylvania and Delaware.

Independently researches, analyzes, and addresses provider issues and concerns to achieve expected goals/outcomes within the 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 to 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.

Qualifications

The candidate must have a bachelor’s degree or equivalent work experience.

Minimum five years’ progressive experience in a health-care-related organization is required, 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, Navinet, and the suite of Highmark applications including but not limited to: 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.

The candidate must be self-motivated with strong interpersonal, analytical, problem-solving, organizational, time management, and written and verbal communications skills.

Ability to independently manage multiple priorities with varying levels of complexity and customer expectations to a successful conclusion with limited supervision is essential, as is the ability to interact effectively with all levels of management, including medical directors.