Provider Partnership Associate

Major Activities

• Independently supports health systems and services community providers, including but not limited to primary care physicians, specialists, ancillary, behavioral health, and institutional providers. Educates providers concerning new initiatives and policy changes that impact their claims payments.
• Handles Provider Validation Roster requests within established timeframes. Ensures completion/submission of all necessary change forms to support the Provider Roster Validation process.
• Ensures that key goals and objectives are accomplished in keeping with established priorities and timeframes.
• 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.
• Maintains and updates the appropriate tracking issues database with current statuses and next steps.
• Conducts root cause analysis and works collaboratively with staff in other business areas to assist with the resolution of complex provider issues and achieve expected goals/outcomes within established timeframes, requesting the support of management when needed.
• Uses the information gained during servicing activities to make recommendations to management regarding the identification of significant opportunities to improve operational efficiency, reduce costs and improve provider satisfaction.
• Establishes and maintains professional and effective relationships between IBC and practice administrators, medical directors, and practitioners to ensure compliance with contractual obligations, applicable State & Federal regulatory requirements, accreditation standards, and corporate policies.

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 Outlook, Word, Access, and Excel (including pivot tables, filters, and formulas).
• Experience using multiple IBC systems and the suite of enGen 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.