Contract Management Operations Specialist

Position Overview:

The Contract Management Operations Specialist is responsible for timely and accurately entering data and the ongoing maintenance of provider contracts in multiple databases.

Essential Functions:

  • Data entry and system mangement for all active data bases that support provider contracts, including Brhams, and MCO PsychConsult.
  • Ensure that all provider contract data is maintained according to the standards established by internal policies and procedures and external regulatory requirements, including the HealthChoices Program Standards and Requirements and the PA PROMISe system enrollment guidelines.
  • Ensure that all contracting data is correct and accurate as reflected in contracting applications and externally facing systems.
  • Implement regular quality assurance activities.
  • Investigate and resolve provider contract inaccuracies and discrepancies.
  • Serve as the Provider Contracting liaison to other CBH departments when cross-departmental collaboration and coordination is needed in reference to provider contract changes, to include supporting existing workflows and processes as well as the implementation of new initiatives
  • Collaborate with the Information Technology and Claims Departments to manage workflows related to provider data
  • Serves as Provider Contracting lead staff for MCO implementation, to include technical assistance and training to Provider Operations and other CBH staff related to provider data and contracting
  • Conduct regular quality assurance analysis to identify and/or resolve any data discrepancies in databases.
  • Works in collaboration with the Provider Contracting team to assess current operational efficiencies and recommend process improvements
  • Attend internal and external meetings related to Provider Contracting functions
  • Perform other duties as assigned to support the day-to-day functioning of the Provider Contracting team as assigned

Position Requirements:

  • Education: Bachelor’s degree preferred
  • License/Certification: N/A
  • Relevant Work Experience: Managed care, behavioral health or related industry experience preferred. Two or more years of experience in customer service, data management, provider relations or credentialing required.
  • Proof of COVID vaccination required
  • Skills:
  • Knowledge of the Pennsylvania Medicaid program
  • Possess a high level of technical aptitude to organize and manage information in multiple system environments.
  • Ability to successfully analyze and find solutions to problems in a fast-paced environment.
  • Excellent written and oral communication skills, interpersonal skills, customer service skills and presentation skills both for a non-technical and technical audience.
  • 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.
  • Ability to work independently and in a team environment.
  • Proficiency in Microsoft Outlook, Word, Excel and PowerPoint.
  • Ability to quickly learn and use new software tools.

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.





PI145302943

Posted
08/30/2021
Type
Full time
Location
Philadelphia, PA 19107, US