Behavioral Health Performance Mgr - Hybrid (PA/NJ/DE)

Independence Blue Cross, LLC in; Philadelphia (Philadelphia County); Hybrid; USD 110,000 - 140,000; Full time

Job summary

Independence Health Group is seeking a Behavioral Health Performance Manager to drive operational performance across BH service lines in a hybrid PA/NJ/DE setting. You will coordinate root-cause analysis, escalate issues, and partner with networks, credentialing, and policy teams to stabilize operations and ensure timely resolutions.

The role requires strong data skills, provider data management, and effective stakeholder communication to protect member experience and regulatory compliance.

Qualifications

• Bachelor’s degree in Business, Healthcare Administration, Public Health, Health Informatics, or related field required.
• Experience managing escalations or cross-functional issue resolution in healthcare.
• Experience with provider data management, credentialing, claims, or configuration processes preferred.

Responsibilities

• Lead change management for BH service, product, billing, and vendor changes with minimal disruption.
• Support client setup and configuration accuracy with operations teams.
• Provide claim escalation oversight and coordinate troubleshooting to identify root causes.
• Manage claims issue resolution and AR escalations across claims, finance, and provider teams.
• Oversee provider data management including directory accuracy and data cleanup.
• Support contract stabilization and monitor provider access and network adequacy.
• Manage network escalations and provide network development support for BH providers.
• Oversee credentialing escalations and ensure providers are active and enrolled.
• Lead provider relations and communications with providers.
• Coordinate provider manual updates and communications on policies and changes.
• Coordinate resolution of executive regulatory issues (PID/DOBI/DOL) and provider complaints.
• Serve as cross-functional liaison to resolve multi-departmental issues and track closure.
• Maintain logs, escalation trackers, and status reporting for BH operations.
• Identify recurring problems and drive process improvements to reduce escalations.
• Maintain HIPAA, CMS, state regulations, and data privacy compliance.

Skills

MS Office Suite

Stakeholder management

Communication skills

Problem solving

Provider network operations knowledge

Education

Bachelor's degree in Business/Healthcare

Tools

Claims systems

Provider data systems

Credentialing systems

Configuration systems

Troubleshooting tools

Job description

Behavioral Health Performance Mgr - Hybrid (PA/NJ/DE)

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.

The Behavioral Health Performance Manager is responsible for driving operational performance, issue resolution, and change management across the Behavioral Health (BH) organization’s service, product, billing, vendor, provider, and network functions. The Performance Manager serves as an operational anchor and cross-functional problem-solver—owning escalation oversight, coordinating multi-departmental resolution, and ensuring that provider‑, claims‑, and regulatory‑related issues are addressed accurately, timely, and to closure.

Serving as a central interface between BH business leadership, operations, and enterprise partners, the Performance Manager oversees service, product, billing, and vendor change management; supports client setup and configuration accuracy; manages claim and accounts‑receivable (AR) escalations; oversees provider data quality, credentialing, and network stabilization; and coordinates the resolution of executive‑level regulatory and complaint matters. The role ensures BH operational commitments are met while maintaining compliance, access, and a high standard of provider and member experience.

This role collaborates closely with Behavioral Health Business Leadership, BH Operations, Provider Network and Provider Data Management, Credentialing, Claims, Configuration, Vendor Management, Policy, Compliance, and Government/Regulatory Affairs to keep operations stable, issues resolved, and stakeholders aligned.

Key Responsibilities

• Lead change management for behavioral health service, product, billing, and vendor changes, ensuring updates are planned, coordinated, communicated, and implemented with minimal operational disruption.
• Support client setup and configuration accuracy, partnering with operations and configuration teams to validate setup, prevent errors, and resolve discrepancies.
• Provide claim escalation oversight and coordinate troubleshooting tools and workflows to identify root causes, expedite corrections, and prevent recurring issues.
• Manage claims issue resolution and accounts‑receivable (AR)–related escalations, working across claims, finance, and provider teams to drive timely and accurate resolution.
• Oversee provider data management—including directory accuracy and ongoing data cleanup to ensure reliable, compliant provider information across systems and member‑facing directories.
• Support contract stabilization and monitor provider access and availability, escalating gaps that could affect network adequacy or member access to care.
• Manage network escalations (e.g., Provider Payment Advocacy / PPA issues) and provide network development support to strengthen and stabilize the behavioral health provider network.
• Oversee and resolve credentialing escalations, coordinating with credentialing and provider teams to keep providers active, compliant, and appropriately enrolled.
• Lead provider relations and communications (including Connect-to-Care / C2C efforts), serving as a responsive point of contact for provider inquiries and concerns.
• Coordinate provider manual updates and related communications, ensuring providers receive accurate, timely guidance on policies, processes, and changes.
• Coordinate resolution of executive‑level regulatory issues and provider complaints, including PID (Pennsylvania Insurance Department), DOBI (NJ Department of Banking and Insurance), and DOL (Department of Labor) matters, ensuring accurate, timely, and well‑documented responses.
• Serve as a cross‑functional liaison to resolve multi‑departmental issues (e.g., PPA, Claims, Policy), convening the right stakeholders, driving accountability, and tracking issues through to closure.
• Maintain issue logs, escalation trackers, and status reporting across the BH operational portfolio, ensuring visibility, follow‑through, and executive readiness.
• Identify recurring problems and drive process improvements that reduce escalations, improve accuracy, and enhance provider and member experience.
• Maintain compliance with HIPAA, CMS, state regulations, and company policies regarding member and provider information and data privacy.

Provider Data & Network Management

• Oversee provider data management—including directory accuracy and ongoing data cleanup to ensure reliable, compliant provider information across systems and member‑facing directories.
• Support contract stabilization and monitor provider access and availability, escalating gaps that could affect network adequacy or member access to care.
• Manage network escalations (e.g., Provider Payment Advocacy / PPA issues) and provide network development support to strengthen and stabilize the behavioral health provider network.

Credentialing & Provider Relations

• Oversee and resolve credentialing escalations, coordinating with credentialing and provider teams to keep providers active, compliant, and appropriately enrolled.
• Lead provider relations and communications (including Connect-to-Care / C2C efforts), serving as a responsive point of contact for provider inquiries and concerns.
• Coordinate provider manual updates and related communications, ensuring providers receive accurate, timely guidance on policies, processes, and changes.

Regulatory & Executive Issue Resolution

• Coordinate resolution of executive‑level regulatory issues and provider complaints, including PID (Pennsylvania Insurance Department), DOBI (NJ Department of Banking and Insurance), and DOL (Department of Labor) matters, ensuring accurate, timely, and well‑documented responses.
• Serve as a cross‑functional liaison to resolve multi‑departmental issues (e.g., PPA, Claims, Policy), convening the right stakeholders, driving accountability, and tracking issues through to closure.

General Operational Oversight

• Maintain issue logs, escalation trackers, and status reporting across the BH operational portfolio, ensuring visibility, follow‑through, and executive readiness.
• Identify recurring problems and drive process improvements that reduce escalations, improve accuracy, and enhance provider and member experience.
• Maintain compliance with HIPAA, CMS, state regulations, and company policies regarding member and provider information and data privacy.

Qualifications

Education

• Bachelor’s degree in Business, Healthcare Administration, Public Health, Health Informatics, or a related field required.

Experience

• 5+ years of experience in healthcare, managed care, or behavioral health, including operations, provider network, claims, or business performance management.
• Demonstrated experience managing escalations, change management, or cross‑functional issue resolution, ideally within a health plan or integrated delivery setting.
• Experience with provider data management, credentialing, claims, or configuration processes strongly preferred.
• Experience supporting commercial, Medicare Advantage, and/or Medicaid lines of business preferred.

Technical Skills

• Strong proficiency with Microsoft Office (Excel, PowerPoint, Word, Outlook) and collaboration/tracking tools (e.g., Teams, Planner, Smartsheet).
• Familiarity with claims, provider data, credentialing, and configuration systems, as well as troubleshooting and issue‑tracking tools.
• Working knowledge of provider network operations, billing, and regulatory/complaint processes (e.g., PID, DOBI, DOL).
• Strong problem‑solving and root‑cause analysis skills, with the ability to resolve complex, multi‑departmental issues to closure.
• Exceptional organizational and follow‑through skills, with the ability to manage multiple concurrent escalations and priorities.
• Strong stakeholder‑management and communication skills across business leadership, operations, provider, and external audiences.
• Sound judgment, ownership, and the ability to operate calmly and decisively in a fast‑paced, escalation‑driven environment.
• Strong attention to detail and commitment to accuracy in data, documentation, and regulatory responses.

Preferred Qualifications

• Experience within a health insurance company, managed care organization, or behavioral health managed care organization.
• Knowledge of provider network development, credentialing, claims/AR, and provider data management practices.
• Familiarity with regulatory and complaint‑resolution processes across Pennsylvania and New Jersey (e.g., PID, DOBI, DOL).
• Process‑improvement credential (e.g., Lean, Six Sigma) or project management certification (e.g., PMP, CAPM).

Success Measures

• Timely, high‑quality resolution of claims, provider data, credentialing, and network escalations.
• Effective coordination of service, product, billing, and vendor changes with minimal operational disruption.
• Accurate, compliant provider data and directories, with measurable reductions in recurring errors and complaints.
• Prompt, well‑documented resolution of executive‑level regulatory (PID/DOBI/DOL) and provider complaint matters.
• Strong stakeholder satisfaction and demonstrable contribution to BH operational stability and performance.

Hybrid

Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri‑State Area of Delaware, New Jersey or Pennsylvania.

Inclusion and Belonging

At IBX, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

About Our Company

Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.

At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com . We’re revolutionizing health care, and our focus is on you!

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.