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

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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

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 accounts-receivable (AR)–related escalations, working across claims, finance, and provider teams to drive timely and accurate resolution.

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.

•       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 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).

Competencies

•       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.