Philadelphia, PA

The Provider Relations Representative acts as the CBH primary point person to CBH’s provider network for education, support and resolution of Provider inquiries. The Provider Relations Representative primarily fosters Community Behavioral Health’s ability to support, develop and maintain a collaborative and positive relationship with the Provider Network, through excellent customer service, in order to ensure that each Provider has continued success within the CBH Provider Network.

Essential Functions:

• Responsible for cross-collaborating with multiple departments within CBH and as the most current source of knowledge for all assigned contracted Providers and Practitioners.
• Responsible for maintaining a repository of information for each of their assigned providers and practitioners.
• Oversee and maintain an assigned caseload of in-network Providers and Practitioners.
• The Representative will serve as a primary source of support and resource for their caseload, along with providing direction and assistance in resolving any emerging concerns as the Provider’s navigate the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS).
• Ensures that all 4 components of DBHIDs (CBH as well as OMH, OAS (CODAAP), and IDS (MRS)) are able to retrieve information upon request regarding the provider/practitioner’s levels of care offered, locations, contact information, provider leadership, billing history, claims issues, and contract status (as needed). Delivers additional information internally as requested, by the Provider.
• Ensures Provider Network remains aware of all DBHIDs initiatives across all 4 components that are Provider related.
• Conduct site visits for all assigned CBH Providers regularly, unless the Provider Relations Representative participates in alternative regularly pre-scheduled CBH meetings at the Provider Site.
• Obtain Provider Capacity updates quarterly. More frequent updates, upon request.
• Provide coverage for Provider Hotline during normal business hours, as assigned.
• Participates in a multitude of meetings on behalf of their providers, to include but not limited to: Network Improvement and Accountability Collaborative (NIAC) prep meetings, compliance meetings, clinical provider meetings, provider teaming’s, claims and billing meetings, and executive level Provider Relations meetings with the CBH Chief Executive Officer (CEO).
• The Provider Relations Representative is responsible for gathering agenda items, taking meeting minutes and ensuring follow up occurs for the executive-level Provider meetings.
• Maintain provider agency licensing, insurance and rate information. Generate Schedule A (contract) change letters.

Position Requirements:

• Education: Bachelor’s degree, preferably in a behavioral health/healthcare administration and/or business administration related field
• License/Certification: N/A
• Relevant Work Experience: Minimum of 3 years of equivalent experience, preferably in the mental health field, with knowledge of managed care and Medicaid/Medicare programs
• Skills:
• Proficiency in Microsoft Office
• Strong analytic and problem solving abilities
• Excellent verbal and written communication skills; ability to communicate with all levels of individuals
• Excellent customer service and networking skills
• Ability to organize and prioritize tasks
• Ability to work as part of a team

Equal Employment Opportunity: Community Behavioral Health (CBH) provides equal employment opportunities to all qualified individuals without regard to race, creed, color, religion, national origin, age, sex, marital status, gender identity, sexual orientation, individual genetic information or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function.

Americans with Disabilities Act: Applicants as well as employers who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case in accordance with applicable law.