Highmark Health
Manager Reimbursement Systems Support
Highmark Health, Pittsburgh, Pennsylvania, United States, 15201
Highmark Inc. Job Posting
If you live within 50 miles of our Camp Hill, PA or Downtown Pittsburgh, PA locations, you will be required to be onsite 3-days a week (Tuesdays, Wednesdays, & Thursdays). This job works with all key stakeholders to successfully design, plan, test, implement, and maintain reimbursement systems and all related reimbursement data tables. Manages all activities related to external customer support or projects related to external partner (e.g ASOs or other external partners) projects and services. Owns Capitation data processes related to cycle payment reports to support capitation payment methods. Essential Responsibilities
Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. Design, plan, test, implement and maintenance of all reimbursement systems and associated data tables, including all fee schedules and methods. Use appropriate analytical data to support critical decision making activities when required. Act as the subject matter expert (SME) regarding Highmark systems functionality and associated process flows. Work effectively within the matrixed environment to assemble and facilitate project and ad hoc teams to reach determined objectives. Manage assigned process, people, and technology against operational metrics and other key indicators to maximize resource productivity and effectiveness. Maintain a working understanding of reimbursement methods, policies, and fee schedules as required to effectively meet and exceed strategic and tactical objectives. Understand and apply UNIT COST TRENDING (UCT) and how available metrics can be applied to existing and future business needs. Manage associated SharePoint sites and coordinate all internal and external communications leading to efficient and effective resolution of customer questions and issues. Coordinate capitation payment activity and manage supporting payment file data. Collaborate with team members to set procedure fees when required. Other duties as assigned. Education
Required Bachelor's Degree in Health Administration Substitutions 6 years of relevant experience in a related field for Bachelor's Degree or 9 years of relevant experience in a related field for Master's Degree Preferred Master's Degree in Health Administration Experience
Required 5 - 7 years of experience working in the Healthcare Industry 5 - 7 years of Management experience 5 - 7 years of Project Management experience Preferred 3 - 5 years of Revenue Management experience 3 - 5 years of experience working in the Health Insurance Industry 3 - 5 years of Data Analytics experience 1 - 3 years of Data Warehousing experience 1 - 3 years of Lean/Six Sigma experience 1 - 3 years of Business Process Design experience Licenses and Certifications
Required None Preferred None Skills
Analytical and Logical Reasoning/Thinking Healthcare Information Systems Health Insurance Microsoft Office Data Analysis Project Planning and Organization Business Process Improvement Personnel Management Data Warehousing EMR Language (Other than English) None Travel Required 0% - 25% Physical, Mental Demands and Working Conditions Position Type Office-Based Teaches / trains others regularly Constantly Travel regularly from the office to various work sites or from site-to-site Occasionally Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Occasionally Lifting: 10 to 25 pounds Rarely Lifting: 25 to 50 pounds Rarely 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. 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. 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
If you live within 50 miles of our Camp Hill, PA or Downtown Pittsburgh, PA locations, you will be required to be onsite 3-days a week (Tuesdays, Wednesdays, & Thursdays). This job works with all key stakeholders to successfully design, plan, test, implement, and maintain reimbursement systems and all related reimbursement data tables. Manages all activities related to external customer support or projects related to external partner (e.g ASOs or other external partners) projects and services. Owns Capitation data processes related to cycle payment reports to support capitation payment methods. Essential Responsibilities
Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. Design, plan, test, implement and maintenance of all reimbursement systems and associated data tables, including all fee schedules and methods. Use appropriate analytical data to support critical decision making activities when required. Act as the subject matter expert (SME) regarding Highmark systems functionality and associated process flows. Work effectively within the matrixed environment to assemble and facilitate project and ad hoc teams to reach determined objectives. Manage assigned process, people, and technology against operational metrics and other key indicators to maximize resource productivity and effectiveness. Maintain a working understanding of reimbursement methods, policies, and fee schedules as required to effectively meet and exceed strategic and tactical objectives. Understand and apply UNIT COST TRENDING (UCT) and how available metrics can be applied to existing and future business needs. Manage associated SharePoint sites and coordinate all internal and external communications leading to efficient and effective resolution of customer questions and issues. Coordinate capitation payment activity and manage supporting payment file data. Collaborate with team members to set procedure fees when required. Other duties as assigned. Education
Required Bachelor's Degree in Health Administration Substitutions 6 years of relevant experience in a related field for Bachelor's Degree or 9 years of relevant experience in a related field for Master's Degree Preferred Master's Degree in Health Administration Experience
Required 5 - 7 years of experience working in the Healthcare Industry 5 - 7 years of Management experience 5 - 7 years of Project Management experience Preferred 3 - 5 years of Revenue Management experience 3 - 5 years of experience working in the Health Insurance Industry 3 - 5 years of Data Analytics experience 1 - 3 years of Data Warehousing experience 1 - 3 years of Lean/Six Sigma experience 1 - 3 years of Business Process Design experience Licenses and Certifications
Required None Preferred None Skills
Analytical and Logical Reasoning/Thinking Healthcare Information Systems Health Insurance Microsoft Office Data Analysis Project Planning and Organization Business Process Improvement Personnel Management Data Warehousing EMR Language (Other than English) None Travel Required 0% - 25% Physical, Mental Demands and Working Conditions Position Type Office-Based Teaches / trains others regularly Constantly Travel regularly from the office to various work sites or from site-to-site Occasionally Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Occasionally Lifting: 10 to 25 pounds Rarely Lifting: 25 to 50 pounds Rarely 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. 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. 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. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org