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.
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.
Skill Sets 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.
