Behavioral Health Performance & Ops Lead (Hybrid)

Independence Blue Cross; 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

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.