Company :Highmark Inc.
Job Description :
This job leads efforts to analyze complex opportunities to reimburse medical items, services or procedures in the most cost-effective place of service and have claims adjudicate under the most effective and appropriate benefit. Leads implementation of the most beneficial resolution. The incumbent operates in a matrixed position that engages, collaborates with, and influences internal and external stakeholders. Requires detailed understanding of how ancillary medical providers receive referrals/orders, and/or maximize revenue by exploiting traditional health plan controls is extremely desirable. Contributes and manages large-scale projects within a variety of ancillary medical provider networks, including post-acute providers.
- Contribute to the development of business and functional strategies related to reimbursement methodologies, pay for value programs, and network management strategies of ancillary health care providers.
- Provide leadership to complex assignments in order to develop solutions that resolve the full scope of the challenge. Develop, communicate and evolve solutions that meet the needs of the business.
- Interpret information from broad based perspective within operational procedures and guidelines and from external sources to make meaningful recommendations to department leadership and key internal stakeholders.
- Other duties as assigned.
- Bachelor's Degree in Business Administration/Management
- Master's Degree in Business Administration/Management
- 5 - 7 years of experience working in the Healthcare Industry
- 1 - 3 years of Provider Payment/Reimbursement experience
- 0 - 1 year of Medical Sales expereince
- 0 - 1 year of Strategic Planning experience
LICENSES AND CERTIFICATIONS
- Analytical and Logical Reasoning/Thinking
- Analysis of business problems/needs
- Communication Skills
- Problem Solving & Decision Making
- Business Strategy
- Leading Change
Language (Other than English)
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
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, 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