Company :Highmark Inc.
Job Description :
This job supervises and coordinates the day to day activities of the UM Intake Coordination team. The incumbent selects, develops and continuously coaches staff to the highest levels of performance. Motivates and team builds through the creation of a work environment and conditions that contribute to highest levels of performance.
- Perform management responsibilities including, but 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.
- Determine workflow for the day and assign work to the team. Monitor and manage daily inventories to ensure adequate staffing and resources are available to ensure performance guarantees and established goals are met and maintained. Monitor calls for quality assurance and compliance.
- Research quality issues and responds to error assessments. Maintain department logs and documentation, analyze for trends in order to identify and initiate future pro-active measures. Produce and analyze reports through various systems and databases, focusing on productivity, quality and compliance.
- Ensure compliance with all regulatory entities (i.e., DOH, CMS, NCQA, etc.) Create, implement, monitor and report on the policies and procedures to ensure all required business/compliance standards are met. Represent the department in compliance audits as it relates to the supervisor functions.
- Act as subject matter expert for benefit plan and claims processing
- Research and investigate any privacy or compliance concerns (CMS, HIPAA, internal policy, etc). Complete root cause analysis and address remediation process with impacted employees.
- Participate in process improvement initiatives as appropriate, which may involve working across teams and with different levels of management.
- Troubleshoot escalated cases, which may involve speaking with providers via phone. At times, build cases in Utilization Review system during high volume times.
- Other duties as assigned or requested.
- High School Diploma/GED
- Bachelor's Degree
- 5 - 7 years in Customer Service
- 1 - 3 years in a management role
LICENSES AND CERTIFICATIONS
- Oral & Written Communication Skills
- Telephone Skills
- Problem Solving & Decision Making
- Healthcare Industry
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 job 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:$43,300.00
Pay Range Maximum:$77,800.00
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 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 )
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