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Associate Provider File Representative Jobs in Pennsylvania

PJM

Associate General Counsel

Audubon, PA · On-site

Represents PJM in proceedings before FERC, including rulemakings, complaints, tariff filings and ... Provides tariff interpretation, upon request, to the PJM Members Committee, the Markets and ...

Airliquidehr

Counter Sales Associate

King Of Prussia, PA · On-site

$16 - $20/hr

The Counter Sales associate provides additional warehouse support as needed.At Airgas, we RESPECT ... Airgas is Hiring for a Counter Sales Representative in King of Prussia, PA! We are looking for you

Ross Stores

Associate Representative, HR

Carlisle, PA · On-site

All while providing a fun and exciting treasure hunt experience. As part of our team, you will ... Audit Associate files, Including I-9s Add required documentation to existing Associate files. Post ...

ASCENSUS

Call Center Representative

Philadelphia, PA · Remote

$19/hr

The associate provides excellent customer service through phone calls, emails and/or online chat ... filings, documentation and reports; or (b) administer payments based on plan information and ...

Ascensus

Call Center Representative

Philadelphia, PA · On-site

$19/hr

The associate provides excellent customer service through phone calls, emails and/or online chat ... filings, documentation and reports; or (b) administer payments based on plan information and ...

Swank Law Office

Be Seen First

Associate Attorney

Kittanning, PA · On-site

$30 - $40/hr

Busy law office seeking an Associate Attorney to become a part of our team ... You will represent clients in legal proceedings, draft and file legal documents and advise clients ...

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Senior Provider Partnership Associate

Philadelphia, PA • On-site

Independence Blue Cross
Insurance Services • 1 - 5K employees
Learn more about Independence Blue Crossexternal

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Re-posted 11 days ago

Independence Blue Cross rating

8.8

Company rating: 8.8 out of 10

Based on 26 frontline employees who took The Breakroom Quiz

Job description

Senior Provider Partnership Associate

The Provider Network Services Senior Provider Partnership Associate supports 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.

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

2. 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.

3. Knowledge of professional billing requirements, reimbursement methodology, IBC/AmeriHealth products, medical policy, and benefits.

4. Proficiency with Outlook, Word, Access, and Excel (including pivot tables, filters, and formulas).

5. Experience using multiple IBC systems and the suite of enGen applications including but not limited to: INSINQ, OCWA, OSCAR, HRP, Aerial, OneHub, Provider Profiles, and PGRS.

6. Proven ability to conduct educational programs using a multi-media approach to small and large groups.

7. Prior experience in a service-oriented role strongly preferred.

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

9. 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.

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.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

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