Jobs
>
Philadelphia

    Provider Partnership Associate - Philadelphia, United States - Independence Blue Cross

    Independence Blue Cross
    Independence Blue Cross Philadelphia, United States

    2 weeks ago

    Default job background
    Description

    Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.

    The Provider Partnership Associate (PPA) will cultivate and maintain relationships with and provide service to institutional and/or professional providers. Institutional providers include all hospitals, hospital systems, and ancillaries. Professional providers include primary care physicians, specialist physicians, and all other credentialed health care professionals. Either an institutional or professional provider may also include the understanding and maintenance of alternative payment arrangements, such as ACOs. Independently researches, analyzes, and addresses provider issues and concerns to achieve expected goals/outcomes within the set timeframes. The PPA will be proactive in providing comprehensive education on new products and networks, instruction on clinical initiatives (ACOs, etc.) and other quality programs, and resolution on matters involving claims and/or payments.

    PPA Responsibilities:

    • 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.
    • Attends onsite, face-to-face, or virtual visits with all provider types and administrators when necessary to communicate changes and provide issue resolution that assists participating providers in the efficient administration of our benefit plans.
    • Develops and delivers provider education and issue resolution in pursuit of network strategies (product portfolio and product changes, payment policy changes, reimbursement methodologies, PEAR/other provider tools, clinical initiatives, etc.).
    • Ensures that key goals and objectives are accomplished in keeping with established priorities and timeframes.
    • Works with Network Operations, or other areas at AmeriHealth New Jersey to identify and resolve provider issues.
    • Establishes and maintains professional and effective relationships with practice administrators, medical directors, and practitioners to ensure compliance with contractual obligations, applicable State & Federal regulatory requirements, accreditation standards, and corporate policies.
    • Provides claims issue resolution from identification/root cause of the problem through the communication of outcome to the provider.
    • Facilitates provider demographic changes with Provider Data Administration.
    • Addresses provider issues using the required ticket and inquiry tracking system processes.
    • Discusses and proposes recommendations to management to support provider engagement strategies and overall provider experience.
    • Completes assigned projects to support corporate initiatives within the timeframe set by management.
    • Supports other members of the team to ensure that service levels and goals are met.
    • Performs other duties as assigned.
    Education

    Bachelor's degree preferred.

    Experience

    •3-5 years of provider relations, or managed care contracting experience. Claims processing, customer service, and/or managed care experience preferred.

    •Proficient in Microsoft Office Suite.

    •Excellent oral and written communication skills.

    •Ability to work independently and within a team.

    •Current state driver's license.

    Hybrid

    Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Cranbury, New Jersey area.
  • Aurora Ventures

    Balance accountant

    3 weeks ago

    Aurora Ventures Philadelphia, United States

    **About Neulken & Partner: ** · We are a nationally and internationally active auditing, tax consulting, and law firm based in Mülheim an der Ruhr. For over 40 years, we have been advising clients in the areas of tax law and business law. · Our firm advises and supports sole pro ...

  • Rainbow Apparel Co

    Director of Ecommerce

    6 days ago

    Rainbow Apparel Co Philadelphia, United States

    The Direct of E-Commerce Consumer Fulfillment is responsible for the planning, operation and management of Rainbow's direct to consumer order fulfillment warehouse and operation. The director reports to the Vice President, Distribution and Director of E-commerce Department. · Res ...

  • Selby Jennings

    Corporate Development Associate

    4 weeks ago

    Selby Jennings Philadelphia, United States

    **Job Title: Corporate Development Associate - Industrials** · **Location: Philadelphia, PA** · Are you a strategic thinker with a passion for driving growth and creating value in the industrials sector? Our client, a leading player in the industrials industry, is seeking a talen ...

  • KPMG-UnitedStates

    Manager, M&A Partnership Transactions Group

    3 weeks ago

    KPMG-UnitedStates Philadelphia, United States

    Business Title:Manager, M&A Partnership Transactions GroupRequisition Number: Function:Tax Services · Area of Interest:State:GA · City:Atlanta · Description: · At KPMG, you can become an integral part of a dynamic team at one of the world's top tax firms. Enjoy a collaborative, f ...

  • InsideHigherEd

    Associate Director, Student Affairs, Graduate Programs

    1 week ago

    InsideHigherEd Philadelphia, United States Administrative Jobs ,

    · Associate Director, Student Affairs, Graduate Programs (Department of Radiation Oncology) · University Overview · The University of Pennsylvania, the largest private employer in Philadelphia, is a world-renowned leader in education, research, and innovation. This historic, Ivy ...

  • Margolis Edelstein

    Associate Attorney

    6 days ago

    Margolis Edelstein Philadelphia, United States

    Due to rapid growth, Margolis Edelstein is seeking Associate Attorneys to join our Labor & Employment practice group in Philadelphia. We are looking for ambitious attorneys ready to engage with clients, insurance carriers, and the court. This role offers autonomy, professional de ...

  • Advice Personnel

    Acquisitions Associate – Multifamily

    1 week ago

    Advice Personnel Philadelphia, United States

    Real Estate Acquisitions Associate – Multifamily (Semi-Remote) · A prominent national real estate investment and management firm is seeking an Acquisitions Associate with skills and savvy to be the driving force behind the firm's ongoing multifamily residential portfolio expansio ...

  • Sodexo

    Catering Manager 3

    1 week ago

    Sodexo Philadelphia, United States

    Unit Description · A passion for helping people and attention to detail are the hallmarks of your success. Join a team where you can make a difference. · Sodexo is seeking Catering Managers for various locations throughout the country to include Alabama, Arizona, Colorado, Con ...

  • Jazz Pharmaceuticals

    Senior Analyst, Security Governance, Risk, and Compliance

    3 weeks ago

    Jazz Pharmaceuticals Philadelphia, United States Full time

    Brief Description: · Jazz Pharmaceuticals is looking for an experienced Senior Analyst– Security Governance, Risk, and Compliance. Reporting to the Associate Director or Director, Security GRC, the Senior Analyst will assist in the oversight of the company's Security Governance, ...

  • Motion Recruitment

    System Engineer

    21 hours ago

    Motion Recruitment Philadelphia, United States

    Our client, a healthcare analytics company, is looking for an Azure System Engineer to join their team remotely on a 6 month contract with potential to be contract to hire. · This role can pay up to $80/hour on W-2. Candidates must be able to work in US without sponsorship. · R ...

  • Burlington Stores

    Territory Human Resources Director

    2 weeks ago

    Burlington Stores Philadelphia, United States

    Overview · If you are interested in growing your human resources career with one of the largest and fastest growing off-price retailers in the nation, join the Burlington Stores team as a Director of Human Resources - Stores Are you an experienced HR leader with excellent commu ...

  • WuXi AppTec

    Senior Procurement Specialist

    2 weeks ago

    WuXi AppTec Philadelphia, United States

    Overview · The Senior Procurement Specialist will be responsible for delivering the Procurement vision and strategy by performing strategic sourcing activities, such as negotiations with suppliers on pricing agreements, processing purchase orders, strengthen communication with i ...

  • Brightside Academy

    Lead Teacher 3rd and West

    2 weeks ago

    Brightside Academy Philadelphia, United States

    Brightside Academy - Brightside Academy is a recognized early childhood education provider offering a safe, supportive, and educational environment focused on child development at every stage. We offer state-of-the-art facilities with a nationally recognized curriculum. · With 30 ...

  • Better Tomorrows

    Social Service Coordinator- Philadelphia 19133

    3 weeks ago

    Better Tomorrows Philadelphia, United States

    Position Description: Better Tomorrows is a mission-focused not for profit organization. We are working to alleviate poverty by providing programs, supportive services, and case management to over 26,000 residents of affordable housing in more than 100 communities across the nati ...

  • Mastery Charter Schools

    Director of High School Redesign

    1 week ago

    Mastery Charter Schools Philadelphia, United States

    **Position Summary**: · Reporting to the Senior Director of High School Redesign, this role will work in collaboration with school-based staff, network level leaders, and external partners to implement a healthcare career connected learning model at targeted campuses across the n ...

  • NAPCO Media

    Senior Content Strategist

    3 weeks ago

    NAPCO Media Philadelphia, United States

    NAPCO Media (), a subsidiary of PRINTING United Alliance, is a fast-paced B2B media organization serving the printing, retail, travel and hospitality and nonprofit industries. We specialize in the creation and cross-channel distribution of exceptional content on print and digital ...

  • InsideHigherEd

    Research Director of Fetal/Neonatal Neurology at CHOP

    1 week ago

    InsideHigherEd Philadelphia, United States Faculty Jobs ,

    · Research Director of Fetal/Neonatal Neurology at CHOP (Associate/Full Professor) · Location: Philadelphia, PA · Open Date: Aug 09, 2023 · Deadline: Aug 09, 2025 at 11:59 PM Eastern Time · Children's Hospital of Philadelphia and the Department of Neurology at the Perelman Schoo ...

  • The Mann Center for the Performing Arts

    Chief Education

    5 days ago

    The Mann Center for the Performing Arts Philadelphia, United States Full time

    The Chief Education and Community Engagement Officer heads the Education & Community Engagement department and reports directly to the President & CEO. This position oversees the Education and Community Engagement department's smooth operation, focusing on fulfilling the Mann's n ...

  • The Cigna Group

    Strategic Senior HR Business Partner

    2 weeks ago

    The Cigna Group Philadelphia, United States Full time

    Evernorth is seeking a Human Resources Business Partner (HRBP, Sr. Advisor) to join the team to drive and enable business outcomes through the development and execution of our people priorities and initiatives. The role will serve as strategic HR partner to our Global Infrastruct ...

  • RSM

    Alteryx Specialist

    1 week ago

    RSM Philadelphia, United States Full time

    We are the leading provider of professional services to the middle market globally, our purpose is to instill confidence in a world of change, empowering our clients and people to realize their full potential. Our exceptional people are the key to our unrivaled, inclusive culture ...