Provider Relations Representative - Hybrid

Provider Relations Representative

UPMC Community Care Behavioral Health is seeking a full-time Provider Relations Representative to join the Network Management team. This hybrid position is based in downtown Pittsburgh's U.S. Steel Tower and includes three in-office days per week, with occasional travel to provider sites. The ideal candidate will bring prior behavioral health experience and a strong commitment to supporting high-quality care across the provider network.

In this role, the Provider Relations Representative will build and maintain strong working relationships with external providers, serving as the primary point of contact for an assigned caseload and offering support to additional caseloads as needed. The representative will ensure providers are well-informed about Community Care's policies, procedures, credentialing requirements, contracting processes, and claims and authorization functions. They will also demonstrate a solid understanding of differences among commercial, Medical Assistance, and other product lines, with attention to how these variations affect provider obligations.

Responsibilities:

1. Ensure providers meet members' clinical needs, comply with service standards, and understand all policies, manuals, billing materials, and authorization procedures.
2. Build and maintain strong relationships with an assigned provider panel, including conducting service meetings, managing supplemental service enrollment, and developing action plans for provider issues.
3. Participate in provider orientation, follow-up sessions, and contribute to newsletters and other educational materials.
4. Collaborate with leadership and colleagues to develop and update provider manuals, handbooks, and network quality indicators, ensuring provider understanding and compliance.
5. Support corrective action plan implementation, identify problems, propose solutions, and ensure issues are fully resolved.
6. Share responsibility for provider phone line coverage and coordinate schedules with team members for consistent support.
7. Balance external provider servicing with internal tasks while meeting deadlines at least 95% of the time

Qualifications:

• B.A or B.S. degree in a healthcare, human services or related field.
• 2 years of experience working in a complex organizational environment.
• 2 years of experience in healthcare or managed care environment.
• Experience as a provider of behavioral health services and/or knowledge of behavioral health provider system strongly preferred.
• Excellent written and oral communication skills.
• Must clearly and consistently articulate standards of care and specifics of the various provider agreements.
• Independent problem-solving skills, including the ability to address issues in a timely and accurate manner.
• Knowledge of public and private delivery systems in behavioral health care.
• Licensure, Certifications, and Clearances: UPMC is an Equal Opportunity Employer/Disability/Veteran