The Provider Specialist is responsible for troubleshooting issues, providing detailed information related to claims, coverage, and benefit plans, and ensuring provider concerns are resolved in a timely and efficient manner.
Key responsibilities include verifying provider credentialing for suspended claims; verifying professional and facility pricing; maintaining thorough and accurate documentation of all inquiries within designated tracking systems; and applying a working knowledge of provider support systems. The role supports providers across the Federal Employee Program (FEP); Local and Commercial PA and AHNJ plans; BlueCard; and Government markets.
Additionally, the position requires participation in special projects and work groups as assigned, as well as collaboration with internal teams to improve provider service processes. Other duties may be assigned as needed to support departmental and organizational goals.
Bachelor's degree in business, Health Care, or a related field/commensurate work experience. In lieu of a BS/BA degree, extensive experience and knowledge of (3-5 years) IBC's various operating systems is acceptable. In-depth knowledge of managed care and professional payment systems is preferred. A demonstrated knowledge of various operational departments including Claims, Medical Policy, Contracting, Specialty Programs, Benefits, and Network Services is preferred. The ideal candidate will be self-motivated, highly organized, detail-oriented, able to handle multiple high priorities, as well as possess above average problem solving, analytical and communication skills (both written and verbal). An established ability to interact with all levels of management is required. Proficiency with Excel and Access are required. Proficiency with Project is 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.