Company :
Highmark Inc.Job Description :
JOB SUMMARY
This position works within the Provider Contracting department and provides analytical and other support for provider contracting, contract administration, and departmental initiatives and projects. The incumbent supports the data and analytical needs of those leading provider negotiations. They monitor and facilitate the contract loading and ongoing contract administration in Highmark systems. This role interfaces directly with other departments (Reimbursement, etc.) on the ongoing departmental needs to support contracting and administration activities.
JOB DESCRIPTION
Monitor activities by tracking the specific terms of each contract and maintaining a mechanism for monitoring and documenting compliance with those terms and perform special studies/audits for all contracts.
Prepare periodic reports that summarize compliance with key responsibilities outlined in the agreement for both internal and external audiences. Analyze data from claim and/or medical record reviews to continually improve the care and service to members and coordinate with the financial recovery areas to retract erroneous or inappropriate payments.
Support provider contracting activities including negotiations, contract development, contract renewal, and financial reimbursement.
Act as the intermediary between the organization and outside entity to ensure all responsibilities as outlined in the contract are fulfilled. Serve as an advocate for managing expectations to achieve positive outcomes. Participate in educational and training sessions for provider billing staff to ensure understanding of and compliance with proper guidelines.
Provide control and processing support for final provider settlements and initiating, documenting, processing, and establishing collection protocols for provider settlements.
Work with sales and customer service to respond to questions/inquiries from customers/members related to appropriateness of services billed by providers.
Other duties as assigned.
EDUCATION
Required
Associate's Degree in Business, Finance, Information Management, Healthcare Administration or Health Related discipline or relevant experience and/or education as determined by the company in lieu of Associate’s degree
Preferred
Bachelor's Degree in Business, Finance, Information Management, Healthcare Administration or Health Related discipline
EXPERIENCE
Required
5 years in the Health Insurance Industry
Preferred
None
LICENSES or CERTIFICATIONS
Required
None
Preferred
None
SKILLS
Analytical and Logical Reasoning/Thinking
Contracts Administration
Problem-Solving
Customer Service
Requirements Gathering
Reporting
Data Gathering and Analysis
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-based
Teaches / trains others regularly
Occasionally
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
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
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:
$68,400.00Pay Range Maximum:
$105,900.00Base 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 any category protected by applicable federal, state, or local law.
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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
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