Hm Health Solutions Inc.
Job Description :
Location – Pittsburgh OR Philadelphia Area OR other surrounding areas.
This job ensures vendors meet expectations for both quality of services and cost as well as ensure both vendors and the Organization comply with regulatory and contractual requirements. Primary tasks include investigating and resolving issues hindering the vendor’s ability to perform; assisting in budget preparation, purchase order management and cost control applicable to vendors; and consulting with senior management applicable to vendor issues impacting regulatory and contractual requirements.
- Investigate and resolve issues hindering Vendor’s ability to deliver expected services to the Organization or our clients and members. Issues are most often raised by internal partners such as Customer Service, Provider Relations, HMHS, Compliance, Sales or others as well as the vendors. Must quickly identify what should be happening, what is actually happening, and then working with appropriate parties to address the issue. Most issues are applicable to failed file feeds or broken system processes thus requiring submission of a system ticket that clearly describes the problem and desired outcome as well as providing more information as needed to help drive quick resolution.
- Schedule and lead periodic operational issues meetings with appropriate Organization and vendor staff. Frequency and duration of meetings will vary by vendor based on needs. Agenda items should be defined in advanced of each meeting. Action items assigned from prior meetings should be tracked and followed-up to ensure resolution.
- Assist in budget preparation, PO management and cost control applicable to vendors. Quantify expected annual spend for each vendor based on contractual terms and applicable cost drivers. Verify vendor invoice are accurate and consistent with contractual terms. Monitor actual year-to-date costs compared to budget and PO amounts in order to explain budget variances as well as adjust PO amounts if needed to ensure payments are made within contracted time frames.
- Keep senior management abreast of issues that endanger the Organization’s compliance with applicable regulations or legal contracts as well as cause poor experience for a large number of members. Communications should include a clear and concise explanation of the problem, probable impact if action not taken and recommendation for how to resolve the issue. Due to complexity of most issues, collaboration with staff from other departments and / or divisions of the Organization as well as the vendor will be required in order to comprehend the full extent of a the issue as well as develop feasible recommendations.
- Other duties as assigned.
- 6 years with increasing responsibility in Finance, business analyst, or systems management
- Bachelor’s Degree in Computer and Information Science or Business Administration/Management
- 3 – 5 years as a Business Analyst
- 1 – 3 years in Audit and Compliance
- 1 – 3 years in Vendor Management
LICENSES AND CERTIFICATIONS
- Contract Management
- Vendor Relations
- Problem Solving & Decision Making
- Written & Oral Presentation Skills
- Healthcare Industry
Language (Other than English)
0% to 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
Does Not Apply
Works primarily out-of-the office selling products/services (sales employees)
Does Not Apply
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Does Not Apply
Lifting: 25 to 50 pounds
Does Not Apply
Referral – Level 1
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.
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
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