Hybrid Autism - Director of Provider Relations at Keystone Human Services

Keystone Human Service is currently seeking a Director of Provider Relations to join our team of professionals in making a positive difference in the lives of our neighbors and the community.

The Director of Provider Relations is an administrative position responsible to develop and maintain a provider network designed to serve participants in the Adult Community Autism Program (ACAP). This position is directly responsible for supervising and implementing all aspects of this fundamental component of the ACAP program.

The Work:

• Maintains thorough understanding of Code of Federal Regulations describing the Prepaid Inpatient Health Plan (PIHP) and all other applicable regulations
• Collaborates to facilitate development and monitoring of the medical necessity review process, including reporting of expiring service authorizations that apply to PIHP provider network and outside vendors submitting claims for medical or behavioral health services to ACAP participants
• Collects and reports financial information
• Provides ongoing monitoring of provider network to ensure regulatory compliance of provider documentation, billing, and payment
• Maintains current state and federal Medicare/Medicaid fee schedules and ensures accurate and timely processing and payment of claims
• Ensures proper credentialing of providers prior to service provision and ongoing as required by state/federal regulations
• Responsible for conducting participant and provider orientation sessions and presenting at workshops to promote understanding of PIHP, ACAP medical home healthcare model and program parameters to various constituencies of KAS and ACAP

Benefits:

• Full time, Exempt position
• Salary starts at $70,000 per year, may increase based on relevant work experience
• Competitive benefits package including medical, dental, vision, 401K and more
• Generous paid time off program
• Tuition reimbursement available per eligibility requirements
• Career development and advancement opportunities

Qualifications:

• Bachelor’s degree; Master’s degree preferred
• Four years of progressive administrative/management experience in a related field
• Healthcare/insurance industry experience is strongly preferred
• Ability to communicate both orally and in writing and to be able to read, interpret and apply written information
• Intermediate computer skills, ability to use Microsoft Word, Outlook and learn web based systems
• Valid driver’s license and, depending on work location, may be required to have daily access to privately maintained and insured vehicle
• Successful completion of the pre-employment process, including clearances and verifications

Keystone Human Services prohibits discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibits discrimination against all individuals based on any category protected by applicable federal, state, or local law.

Disclaimer: The preceding job description has been designed to indicate the general nature and level of work performed by employees within this job. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.