Job ID: J120128
Company: HM Health Solutions Inc.
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
This job drives service delivery and business management for a given office (Front Office, Operations) of the Consulting Services division of HM Health Solutions. Builds out and advances their given Practice area to implement capabilities and solutions for multiple HMHS customers (existing and future) to achieve revenue and profitability targets.
The incumbent executes approaches that facilitate and drive adoption of the Enterprise Health Solutions capabilities by HMHS Customers, within a highly complex matrix environment. Serves as a trusted adviser to the Customer’s management team, drives attainment of value through collaborative and effective advisory management services, serving in or architecting co-management arrangements with customers, and providing innovative adoption-oriented (internal functions and market-facing) approaches with customers.
The incumbent designs and implements complex and transformation changes at a client site, building methods and a consulting workforce that is viewed as top tier in the industry to develop and implement solutions for a diverse client base of customers. An additional critical role will be to serve as a visible and demanding advocate for the EHS in strategic planning and related governance processes with the Highmark Health Plan customer and other ASP clients.
The incumbent is a significant contributor and leader of the platform planning processes to make sure market needs are exceeded/met and that HMHS platforms are viewed favorably in the market place and with our customer base. Conducts direct engagement in HMHS business development efforts to cultivate new partnership opportunities with other prospective customers by representing HMHS in executive level presentations, business case development, evaluating other Plans assets and business value to Highmark and other support activities to grow additional scale.
the incumbent will likely have one of five areas of accountability:
- Provider Management Focus is defined as those people, process and technology solutions focused on Provider Pricing, Credentialing, Payment Innovation and Contract Management techniques as it relates to both the Payer and Provider systems in an integrated and none integrated delivery setting.
- Clinical & Government Programs is defined as those people, process and technology solutions focused on Care, Disease and Utilization Management along with Health and Wellness as it relates to both the Payer and Provider systems in an integrated and non-integrated delivery setting. In addition, those areas & programs related to Medicaid, Medicare, Mandates and HCR would be a focus of this leader.
- Front Office is defined as those people, process and technology solutions focused on Sales, Product Management, Benefit Management and Member/Group/Broker channel management as it relates to both the Payer and Provider systems in an integrated and non integrated delivery setting.
- Operations is defined as those people, process and technology solutions focused on Claims Processing, Service, Enrollment, Document Generation, Disbursement, Billing, Spending Account etc management as it relates to both the Payer and Provider systems in an integrated and none integrated delivery setting. Some of these arrangements will be in an Application Support Model (ASP) while others will be in a Business Processing Arrangement (BPO) with the Highmark Health Plan.
- Enterprise/Corporate is defined as those people, process and technology solutions focused on Corporate Systems like Work Day, Oracle/PeopleSoft, Integrated Delivery Focused platforms as they are supported by HMHMS and/or utilized by ASP Clients as it relates to both the Payor and Provider systems in an integrated and non integrated delivery setting.
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.
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.
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