Create a Job Alert.

Enter your email below to save this search and receive job recommendations for similar positions.
Thank you. We'll send jobs matching these to
You already suscribed to this job alert.
No Thanks
US
What job do you want?

Create Job Alert.

Get similar jobs sent to your email

Apply to this job.
Think you're the perfect candidate?
Apply on company site

You’re being taken to an external site to apply.

Create an account to get recommended jobs that match your resume and apply to multiple jobs in seconds!
On the next page, you'll build a resume in 3 steps thanks to our AI technology
8-15 characters
Contains Number
Contains Lowercase
Contains Uppercase
Contains Special Character

You’re being taken to an external site to apply.

Enter your email below to receive job recommendations for similar positions.
Provider Contracting Specialist at Community Behavioral Health

Provider Contracting Specialist

Community Behavioral Health Philadelphia, PA Full-Time
Apply on company site

Create Job Alert.

Get similar jobs sent to your email

Position Overview: 

The Provider Contracting Specialist works in collaboration with the Manager of Provider Contracting and Provider Contracting Supervisor  to ensure provider contracts are created and maintained in a manner that consistent with both Community Behavioral Health standards and Federal and State regulations governing practitioner and facility licensing, Medicaid enrollment and reimbursement, and service and financial reporting requirements.

Essential Functions

  • Responsible for obtaining and organizing relevant, accurate information and data required to create, revise and terminate provider contracts for CBH Network Providers, including the completion of all necessary paperwork to support contract changes (i.e. Blue Folders)
  • Maintains provider contract files in accordance with the standards established by CBH internal policies and procedures governing contract management and external regulatory requirements, including the PA HealthChoices Program Standards and Requirements and PA PROMISe system enrollment guidelines.   
  • Assist in the approval process for out-of-network/non- participating provider contracts  
  • Track contract and licensing application flow, including renewal and termination dates, and provide regular status updates to the Manager of Provider Contracting  and Provider Contracting Supervisor
  • Appropriately notifies all departments regarding contract additions, terminations and changes 
  • Serve as the lead staff for the initial credentialing of facilities entering the CBH Network, to include cross-departmental coordination and collaboration of the required processes and the completion of all necessary paperwork.  Credentialing activities include review of provider staff files, business documents, and policies and procedures and provider site visits.
  • Provide support in determining if Out of Network providers meet CBH and State standards for Medicaid reimbursement, including out-of-state individual practitioners and facilities.
  • Assist in the cross-departmental provider monitoring process related to newly contracted services, to support the mutual goal of achieving consistency related to the agreed-upon service model   
  • Assure that all Encounter Data associated with paid claims is reported to the PA Office of Mental Health and Substance Abuse Services (OMHSAS) consistent with the Behavioral Health Services Reporting Classification Chart (BHSRCC)
  • Analyze internal reports related to provider contracts and follow up internally and externally to address any identified issues
  • Work in collaboration with the Provider Operations, Finance and Information Services Departments to ensure the data in the CBH contract data base is accurate, complete, and up-to-date, including the CBH Level of Care System
  • Maintain a working knowledge of contracting policies, procedures and processes and provide cross-functional support to other units within the Provider Operations department and other CBH Departments
  • Works in collaboration with the Manager of Provider Contracting, Provider Contracing Supervisor  and the Provider Operations management team to assess current operational efficiencies and recommend and implement process improvements
  • Represent the CBH Provider Contracting unit at both internal and external meetings
  • Coverage of the CBH Provider Hotline as assigned

Position Requirements: 

  • Education: Bachelor’s degree in behavioral health or a related field required, Master’s degree preferred License/Certification:   N/A
  • Relevant Work Experience: Minimum of 5 years healthcare experience, preferably in a behavioral health system with knowledge of managed care and Medicaid programs
  • Skills:
  • Advanced proficiency in various computer applications, e.g. word processing, excel spreadsheet, e-mail, tracking systems, etc.
  • Excellent communication skills 
  • Detailed- minded 
  • Knowledge of the PA PROMISe system
  • Ability to develop alternative solutions to problems; comparing and analyzing data; preparing clear, concise and thorough reports, documents.
  • Very strong customer service orientation, positive attitude, and change oriented.
  • Must be able to prioritize multiple responsibilities and manage a large workload within tight deadlines.
  • Ability to independently plan, organize, prioritize, schedule, coordinate, and make decisions relating to assigned tasks.
  • Excellent problem-solving skills and self-motivation. Self-starter, takes initiative, and the ability to work independently.
  • Ability to work with highly sensitive and confidential matters.
  • Willing to travel locally and regionally for provider agency site visits 

 

Recommended skills

Program Standards
Medicaid
Process Improvements (Business)
Scheduling
Managed Care
Credentialing
Apply to this job.
Think you're the perfect candidate?
Apply on company site

Help us improve CareerBuilder by providing feedback about this job: Report this job

Report this Job

Once a job has been reported, we will investigate it further. If you require a response, submit your question or concern to our Trust and Site Security Team

Job ID: 1584

CareerBuilder TIP

For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Learn more.

By applying to a job using CareerBuilder you are agreeing to comply with and be subject to the CareerBuilder Terms and Conditions for use of our website. To use our website, you must agree with the Terms and Conditions and both meet and comply with their provisions.