Senior Network Coordinator

🔍 Philadelphia, Pennsylvania

📁: Provider Network Services

📅   : 180188 Requisition #

📅   : Apr 02, 2018 Post Date

The Senior Network Coordinator is responsible for servicing a defined segment of multiple provider types and or integrated delivery systems with moderate complexity in PA and DE and is the single point of contact for all reported issues. Provider types includes: PCPs, specialists, hospitals, and ancillary providers and integrated delivery systems.

Additional Responsibilities

Independently organizes and conducts initial orientations and servicing meetings as needed with defined providers.
Independently performs research and analysis of all provider issues.
Maintains and updates the appropriate tracking issues database with current statuses and next steps as well as maintain reports that are clear, concise, and appropriately written for management and external audience
Independently conducts root cause analysis, analyzes claim files and reporting, and actively engages core areas within the organization to facilitate and assist with driving resolution or workarounds of complex provider issues with management approval and some management guidance and direction.
Uses information gained during servicing activities to make business cases and assist in driving activities regarding the identification of significant opportunities to improve operational efficiency, reduce cost, and improve provider satisfaction with management approval and some management guidance and direction.
Proactively identifies policy and procedural issues and recommends and drives potential resolution by working with core areas within the organization with management approval and some management guidance and direction.
Provides adhoc assistance to other team members within Provider Network Services
Provide key insights and recommendations to improve provider experience and minimize future servicing issues during contract negotiations .
Establishes and maintains professional and effective relationships between Independence and practice administrators, medical directors, practitioners, managed care directors and vice presidents and ensure compliance with contractual obligations, applicable State and Federal regulatory requirements, accreditation standards, and corporate policies.
Ensures that expected goals/outcomes are achieved within the set timeframes.
Displays appropriate behavior in high stress situation, for example when dealing with difficult people internally and externally and during high volume peak workloads and/or post production or system implementation as well as act as a role model to other team members within Provider Network

Qualifications

Bachelor's degree or equivalent work experience required.
Minimum five years' progressive experience in a healthcare-related organization is required, with experience in Provider Networks, Contracting, Claims Processing, or Managed Care Operations strongly preferred.

Diversity, Equity, and Inclusion

At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

Vaccination Update

This job requires that you demonstrate you have been fully vaccinated for COVID-19 prior to the start of employment, to the extent permitted by law.

About Our Company

Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.

At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!

Equal Employment Opportunity

Independence Blue Cross is an Equal Opportunity and Affirmative Action 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.

Agency Disclaimer

All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.