Job Description :
This job supervises and coordinates the day to day activities inherent to the enrollment, membership, and billing functions for Medicare, individual, social mission, commercial, and partnership business. The incumbent is responsible for ensuring the timely and accurate processing of member enrollment and billing transactions, assisting in audits conducted by internal and external entities, providing direction and instruction to team as well as overseeing the distribution of work. Selects, develops and continuously coaches staff to the highest levels of performance creating a positive work environment that embodies the company core values.
- Perform management responsibilities to include, but are 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.
- Monitor work intake, productivity, and projects and assign work to the team accordingly. Monitor and manage inventories to ensure adequate staffing and resources are available to meet performance guarantees and established goals are met and maintained. Monitor to ensure quality assurance and regulatory compliance.
- Ability to analyze data, measure outcomes and develop action plans. Ability to analyze data, measure outcomes and develop action plans. Excellent written and verbal communication skills with ability interact with all levels of the organization; effective communication of data analysis, outcomes, complex process requirements and action plans to staff, corporate partners, etc.
- Identify, implement, and adhere to multi-state and federal government regulations, corporate policy mandates, corrective action plans, compliance requirements and process improvement initiatives impacting systems, operating platform and associated business processes and workflows.
- Serve as subject matter expert (SME) and liaison to various business units including Sales, Product P&Ls, Compliance, Government Agencies, Plan Partners, and HMHS. Interact with all levels of management from the various business units. Lead problem solving sessions to solve complex problems that may arise. Writes and maintains department procedure documentation and all training materials. Other duties as assigned or requested.
- Other duties as assigned or requested.
- 3 years of membership, billing and enrollment or equivalent operational experience
- 1 year of leading or supervising others
- 3 years of Process Improvement
LICENSES or CERTIFICATIONS
- Knowledge of multiple processing systems and workflows
- Ability to interpret all government regulations
- Knowledge of Highmark products
Languages (Other than English)
PHYSICAL, MENTAL 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, 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.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
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