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 outreaches, BCBS demographic audits, member reported directory issues, credentialing inquiries, assignment of work, education outreaches 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.

·         Coordinates 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. 

·         Previous experience and or knowledge of claim processing is preferred.

·         Other duties as assigned.

Experience

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

Skills

Proficient in MS Office application

Excellent oral communication skills

Knowledge of contracting terms preferred

Education

Bachelors preferred.

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.