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Behavioral Health Provider Network Executive
2 months ago
Job Summary:
The Behavioral Health Provider Network Executive is responsible for building and maintaining strong relationships with contracted Behavioral Health providers. This role involves working with single or multiple practices in various locations, integrated delivery systems, or other provider organizations.
Key Responsibilities:
- Develop and maintain in-depth knowledge of the company's contracts and provider performance.
- Identify, develop, and conduct provider orientation sessions, educational visits, and resolve provider issues.
- Monitor and manage the provider network to ensure access to services throughout the company's territory, adhering to State and Federal contract mandates.
- Identify and solicit qualified providers to participate in the company's network, ensuring financial integrity and contract management requirements.
- Maintain a complete understanding of company reports and metrics to evaluate provider performance and implement plans for improvement.
- Develop and implement methods to improve relationships with providers.
- Assist in corrective actions, including termination, following company policies and procedures.
- Support the Quality Management department with credentialing, re-credentialing, and investigation of member complaints and quality issues.
- Maintain a functional working knowledge of Facets, including the provider database, and relay information about additions, deletions, or corrections to the Provider Maintenance Department.
- Deliver accurate and timely activity and metric reports as required.
Requirements:
- Experience working with Behavioral Health providers required.
- Bachelor's Degree.
- 3 to 5 years' experience in a Provider Services position working with Behavioral Health providers.
- 5 to 10 years' experience in the managed care/health insurance industry with demonstrated strengths in knowledge of company policies and procedures, provider contracting, credentialing, billing, and payment.
- Substantive Account Executive experience with high-impact, high-dollar, and critical provider groups.
- Medicaid experience required.
- Strong leadership skills and ability to navigate change.
- Ability to work cross-functionally, problem-solve, and navigate bureaucracy.
- Working knowledge and proficiency with Microsoft Office products.
- Ability to manipulate spreadsheets and data in Microsoft Excel.
- Excellent listening skills.
- Strong verbal and written communication skills.
- Detailed-oriented with strong organizational and time management skills.
- Self-motivated.
- Scheduling, planning, and follow-up skills.
- Ability to interface effectively with a diverse population.
- Ability to work independently and with teams.
- Broad knowledge about the community, specific health issues, and health and social service systems.
