Job Description

Company :

Highmark Inc.

This job manages a team of provider file representatives who are responsible for the system implementation of all provider contracts and provider demographics. Oversees an internal audit quality review program designed to ensure provider data accuracy and completeness, and to provide staff with feedback on their quality scores. Provides weekly management reports on quality, work-in-progress, volume trends and training opportunities. Responsible for training, updating departmental procedures, and ensuring consistent processes throughout the department.

ESSENTIAL RESPONSIBILITIES

• Supervise non-exempt employees.
• Oversee internal audit/quality review program.
• Maintain and enforce departmental policies and procedures.
• Train staff.
• Meet internal and regulatory standards for timely data entry and report submissions and filings.
• Inventory Management
• Other duties as assigned or requested.

QUALIFICATIONS

Minimum

• High school diploma or GED
• 1 year of experience working with providers in areas such as enrollment and maintenance
• 1-2 years of experience with staff oversight and/or development, either in a formal or informal capacity

Preferred

• 1 year of experience performing Medicaid and /or Medicare systems setup of provider contracts and provider demographics
• 3 years of experience in a provider data maintenance department of a managed care organization
• Inventory management of production work load
• Direct supervisory and/or management of staff (monitor day to day workloads, disciplinary reviews)
• Project management

Skills

• Demonstrated behavior showing the ability to manage the work of others in a volume-driven environment
• Demonstrated work experience exhibiting strong business, analytical, judgment, and communication skills in a corporate environment
• Knowledge of claims and various provider contracting methodologies
• Understanding of software applications used Highmark Wholecare®, such as Managed Health Care System, CACTUS, OnBase Document Management and/or OnBase Workflow
• Ability to communicate effectively in oral and written form to a wide range of audiences representing a broad cross-section of intellectual abilities and interests

SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees?

Yes, number of direct reports: 18

WORK ENVIRONMENT
Is Travel Required?
No

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$62,700.00

Pay Range Maximum:

$97,200.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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