The Manager of Provider Contracting provides leadership, guidance and oversight for all activities related to provider contract management and the initial credentialing process for facilities.
- Serve as a subject matter expert for the management of the provider contract management system.
- Manage the technical aspects of the contracting process, including contract initiation, amendments, and terminations.
- Oversee the maintenance of the provider contracting system ensuring all provider contracts, both in- and out-of-network, are developed, configured, and loaded appropriately.
- Develop, implement, and monitor policies and procedures to ensure compliance with state, federal, and NCQA regulations.
- Oversee structuring of provider contracts to ensure that encounter data associated with paid claims are reported to the Office of Mental Health and Substance Abuse Services (OMHSAS) consistent with the Behavioral Health Services Reporting Classification Chart (BHSRCC).
- Manage facility-related initial credentialing; ensure all credentialing functions are operating timely and according to policy and regulatory requirements.
- Ensure Provider Contracting staff remain current in all aspects of federal and state regulations, policies, and procedures and responsible to make the necessary modifications to internal policies and procedures to reflect changes.
- Build and sustain a high performing provider contracting team to ensure growth and expanded knowledge.
- Work closely with internal CBH departments to communicate identified problems and issues that arise within provider contracting.
- Interact and work closely with all relevant departments within CBH and DBHIDS to ensure provider contracting strategies are supported and consistent with other departmental initiatives
- Oversight of the day-to-day operations of provider contracting unit to ensure departmental objectives are being achieved accurately, timely and consistently.
- Provide guidance on technology and systems to improve team efficiency and effectiveness.
- Participate in relevant committee meetings with CBH and DBHIDS staff, as relates to how contracting activities are tied to larger service development
- Perform other duties as assigned.
- Education: Bachelor’s Degree in a health-related field; 5-7 years of experience in the health care industry with background in provider contracts and reimbursement; MBA, MHA or related graduate degree preferred
License/Certification: Coding Certification desired.
- Minimum of 2 years of experience managing/ supervising employees
- Understanding of HealthChoices Program Standards and Requirements and PA PROMISe system enrollment guidelines.
- Knowledge of Pennsylvania Medicaid reimbursement structures and payment methodologies
- Knowledge of ICD-10 and CPT codes desired.
- Excellent written and verbal communication skills.
- Exceptional partnership and interpersonal skills.
- Results driven, able to self-direct and work independently as well as perform in a team environment.
- Ability to multi-task, pay close attention to detail and be flexible in a fast-paced and growing organization.
- Strong organizational and analytical skills.
- Superior problem solving, decision-making skills.
- Exceptional teambuilding skills and maintenance of positive relationships across CBH and DBHIDS teams.
- Demonstrate strength in technical abilities such as excel, word, PowerPoint and other computer programs and databases.
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.
This job profile reflects management’s assignment of current duties, responsibilities, and essential functions; it does not prescribe all or restrict the tasks that may be assigned now, or in the future, relevant to the responsibilities for this position. Community Behavioral Health (CBH) may change the specific job duties with or without prior notice based on the needs of the organization.
Attention To Detail
Complex Problem Solving