Provider Prtnrship Support Adm

Summary

The Provider Partnership Support Specialist (PPSS) supports day-to-day provider service functions, including but not limited to provider data changes, VEDA data accuracy outreach, BCBS demographic audits, member-reported directory issues, credentialing inquiries, assignment of work, education outreach, and other outreach projects.

Responsibilities

• Discuss new policy implementation, reviews utilization reports, and recommends sources of more efficient utilization with providers.
• Provides internal departments with network information on request and follows up on specific provider education requests.
• Assigns inquiries to the appropriate PPA’s from incoming mailboxes and work queues.
• Investigates and provides resolution to provider inquiries.
• Resolves complaints and operational issues in collaboration with Provider Partnership Associates (PPAs).
• Recommends revisions to provider materials when appropriate.
• Covers activities with network operations department on specific provider claims re-processing issues.
• Communicates results to providers as required.
• Completes demographic changes and follows through to assure that all demographic changes are accurately processed.
• Completes requests for member movements when needed.
• Confirm termination or merger acquisitions in support of letter notification process.
• Supports PPA’s with administrative tasks associated with resolving provider issues.
• Develops and maintains effective business relationships.

Experience

2-3 years of healthcare or insurance customer service or related experience required.

Skills

• Proficient in MS Office applications
• Excellent oral communication skills
• Knowledge of contracting terms preferred

Education

A bachelor's degree is preferred.

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.

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.