Provider Contracting Specialist

CBH is a dynamic organization dedicated to providing access to high-quality, accountable care to improve the health and mental wellness of our members. As part of our growth, we are seeking a detail-oriented Provider Contracting Specialist to join our team. CBH offers a robust compensation and benefits package, including:

• Family Planning, Fertility, Adoption Benefits
• 403B Retirement Plan
• PTO Days/Sick Days
• Wellness Program
• Employee Assistance Program
• Health, Dental, Vision Insurance
• Medical, Prescription Drug Insurance
• Tuition Reimbursement
• Commuter Benefits
• Flexible Spending

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.

Core Expectations:

CBH will hold each employee accountable to the following expectations which align with our mission, vision, and corporate code of conduct.

• Perform key responsibilities as detailed in this job description in a dependable, responsible, and positive manner
• Serve as a role model by exemplifying professional behavior, language, skills, and attire in order to promptly and accurately service the needs of stakeholders and their families
• Assure adherence to CBH policies and procedures so that all work is of the highest quality and delivered in the most culturally competent and cost-effective manner
• Promote and manage diversity and acceptance within CBH and with all stakeholders by honoring and respecting their individuality, dignity and rights
• Offer suggestions and develop solutions to help promote effective and efficient work processes and innovative programs
• Actively participate in required meetings and complete all mandatory trainings
• Maintain high levels of advocacy and confidentiality to ensure the success of CBH and our mission

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 activitie 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 Contracting 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
• 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

Core Competencies:

• Teamwork and Collaboration: Build and sustain relationships with co-workers and stakeholders and support efforts and deliverables. Encourage unity and help remove barriers to productivity and success.
• Respect: Treat each other and our members and stakeholders with respect and sensitivity, recognizing the importance of diversity.
• Member Centric: Focus on the needs of our members by providing value-added services, promoting strong relationships and going beyond basic expectations to achieve the best possible outcomes.
• Honesty and Integrity: Be open and honest in all we do. Maintain the highest level of integrity at all times.
• Commitment to Service Excellence: Challenge ourselves to be forward-thinking and committed to providing total member and stakeholder satisfaction, first-in-class service and high quality, innovative programs.
• Compassion and Empathy: Demonstrate a deep appreciation for another's situation and point of view. Pay attention to emotional cues, listen effectively and show an exceptional level of caring about each person's perspectives and circumstances.
• Problem Solving: Build and implement logical solutions to resolving challenges/issues by using individual knowledge and experience while taking resources, constraints and CBH values into consideration.
• Initiative and Self-Directed: Proactively manage time and resources in a way that ensures that all work is done in the most efficient manner while identifying and implementing initiatives without interventions from co-workers, supervisors or stakeholders.
• Flexibility and Adaptability: Adjust approaches and behaviors in order to meet the constantly changing environment head-on and accomplish CBH and individual goals. Strive to adapt to, accept and embrace change within areas of responsibility.
• Communication: Effectively and appropriately share thoughts, ideas and information - both written and oral. Respectfully listen to co-workers and stakeholders to gain a full understanding of issues/situations.

Leadership Competencies:

• Strategic Thinking: Understand and integrate the long-term vision of CBH and focus current activities on what is critical to achieve future success including formulating objectives/priorities and developing and implementing breakthrough ideas.
• Leadership: Effectively manage and guide efforts to address challenges and drive continuous improvement for CBH's programs, services and processes. Develop and implement effective strategies and appropriate interpersonal styles to influence and guide others.
• Employee Development: Recognize and promote the necessity to hire, assess, develop and retain high quality talent. Acknowledge strengths and weaknesses in team members through an ongoing performance management process that provides timely feedback in order to help them develop and enhance performance.

Philadelphia Residency Requirement:

• The successful candidate must be a current Philadelphia resident or become a resident within six months of hire.

U.S. Authorization Requirement:

• CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.

Equal Employment Opportunity:

• We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.

Requesting An Accommodation:

• CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired.
• If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at View email address on click.appcast.io