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

Independence Blue Cross, LLC; Philadelphia (Philadelphia County); Hybride; USD 120 000 - 150 000; Plein temps

Avantages offerts par ce poste

Hybrid work model

Résumé du poste

Independence Blue Cross, LLC in Philadelphia seeks a Behavioral Health Performance Manager to drive operational performance across BH service, product, billing, vendor and network functions. You will coordinate crossfunctional issue resolution, escalation management, and regulatory responses to ensure timely, accurate outcomes while upholding HIPAA and member experience standards.

Hybrid work in the TriState Area is supported.

Qualifications

• Bachelor's degree in business, healthcare administration, or related field required.
• 5+ years in healthcare, managed care, or behavioral health operations.
• Experience managing escalations and crossfunctional issue resolution.

Responsabilités

• Lead BH service, product, billing, and vendor change management.
• Oversee provider data quality, credentialing, and network stability.
• Coordinate regulatory responses and executive issue resolution.
• Maintain issue logs and support BH operational stability.

Connaissances

Change management

Escalation management

Provider data

Credentialing

Regulatory compliance

Operations leadership

Formation

Bachelor's degree in Business/Healthcare Administration

Master's degree preferred

Outils

Microsoft Office

Smartsheet

Issue tracking tools

Description du poste

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 wellbeing 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 crossfunctional problemsolverowning escalation oversight, coordinating multidepartmental resolution, and ensuring that provider, claims, and regulatoryrelated 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 accountsreceivable (AR) escalations; oversees provider data quality, credentialing, and network stabilization; and coordinates the resolution of executivelevel 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

Service, Product, Billing & Vendor Change Management

• 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.

Claims Oversight & Escalation Resolution

• 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 accountsreceivable (AR)related escalations, working across claims, finance, and provider teams to drive timely and accurate resolution.

Provider Data & Network Management

• Oversee provider data managementincluding directory accuracy and ongoing data cleanupto ensure reliable, compliant provider information across systems and memberfacing 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 ConnecttoCare / 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 executivelevel 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 welldocumented responses.
• Serve as a crossfunctional liaison to resolve multidepartmental 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, followthrough, 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.
• Master's degree (e.g., MHA, MBA, MPH) preferred.

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 crossfunctional 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 issuetracking tools.
• Working knowledge of provider network operations, billing, and regulatory/complaint processes (e.g., PID, DOBI, DOL).

Competencies

• Strong problemsolving and rootcause analysis skills, with the ability to resolve complex, multidepartmental issues to closure.
• Exceptional organizational and followthrough skills, with the ability to manage multiple concurrent escalations and priorities.
• Strong stakeholdermanagement and communication skills across business leadership, operations, provider, and external audiences.
• Sound judgment, ownership, and the ability to operate calmly and decisively in a fastpaced, escalationdriven 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 complaintresolution processes across Pennsylvania and New Jersey (e.g., PID, DOBI, DOL).
• Processimprovement credential (e.g., Lean, Six Sigma) or project management certification (e.g., PMP, CAPM).

Success Measures

• Timely, highquality 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, welldocumented resolution of executivelevel 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 TriState Area of Delaware, New Jersey or Pennsylvania.