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Finance@2X
J207113

Supervisor Risk Revenue Programs

Highmark Inc.

Company :

Highmark Inc.

Job Description : 

JOB SUMMARY

***This position is remote from anywhere***

This job provides oversight of the Unconfirmed Diagnosis Program within the Risk Revenue Department.  The incumbent is responsible for the end-to-end process which includes intake from providers, supervision of coding functions, management of temporary production staff and on-going process improvement.  Reports to the Manager of Prospective Programs and works closely with Revenue Program Management Strategy Analysts to continuously implement procedure improvements and advance the market share of the Unconfirmed Diagnosis Program Program.

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. 
  • Create, maintain and communicate provider reimbursement and bonus model - this includes calculating payouts, accruing appropriate amounts and ensuring payout.   It also includes communicating the payout information.   Also responsible for the program budgets and PO process.
  • Supervise coding vendor contracts, implementing subsequent performance measures and administering/managing Service Level Agreements 
  • Develop and implement process improvement strategy to ensure the timely and accurate processing of Unconfirmed Diagnosis Code forms
  • Collaborate with Coding/Quality Team to ensure quality and completeness of coding protocols completed by Vendors.  Score vendors and provides feedback on quality to the vendors. Work through next steps with vendors when quality standard is not met
  • Act as secondary strategist on Unconfirmed Diagnosis Code program development and launch criteria. Reviews analytics and ensure criteria and logic are accurate.  Deliver program by specified implementation dates.  Liaison to Analytics Team for Program specifications
  • Provide timely reports to Revenue Program Management Team on Unconfirmed Diagnosis Code volume and completeness at the provider level.  Interpret reports and identifies potential opportunities for improvement.    Work with others across departments to develop and implement education or improvement plans.   
  • Other duties as assigned or requested.

EDUCATION

Required

  • Bachelor's Degree in Health Administration, Business Administration/Management, and Finance

Substitutions

  • 6 years of Risk Revenue or Related Experience

Preferred

  • Master's Degree in Heath Administration

EXPERIENCE

Required

  • 5 - 7 years of Financial Reporting experience
  • 5 - 7 years of Healthcare Industry experience
  • 3 -5 years of Process Improvement experience
  • 3 - 5 years of Provider Communications experience

Preferred

  • 3 -5 years of Risk Revenue experience

LICENSES OR CERTIFICATIONS

Required

  • None

Preferred

  • None

SKILLS

  • Business Process Improvement
  • Financial Reporting
  • MS Word
  • MS Excel
  • Supervisory Experience
  • RFP
  • Contracts Management

Language Requirement (other than English)

None

Travel Required

0% - 25%

Physical, Mental Demands and Working Conditions

Position Type

Office-Based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required 

Yes

Lifting: up to 10 pounds

Does Not Apply

Lifting: 10 to 25 pounds

Does Not Apply

Lifting: 25 to 50 pounds

Does Not Apply

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. 

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 their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

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 their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

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 number below.

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

California Consumer Privacy Act Employees, Contractors, and Applicants Notice


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