Provider Relations Representative

Community Behavioral Health.•Philadelphia, PA

23h•$50,622 - $58,000

About The Position

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.

Requirements

Bachelor’s degree, preferably in a behavioral health/healthcare administration and/or business administration related field
Minimum of 3 years of equivalent experience, preferably in the mental health field, with knowledge of managed care and Medicaid/Medicare programs
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

Responsibilities

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.