Job ID: J130903
Company: Gateway Health Plan
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Sep 6, 2018
This job provides overall direction, sets goals and leads the overall revenue program management strategy around revenue cycle business and operations. Functions as the business owner of risk analytics, provider engagement, risk adjustment data submissions (RAPS, EDPS, , Medicaid state- based encounter submissions), identifies and applies best practices and processes to ensure efficacy and accuracy of risk adjustment programs. Identifies and recommends both strategic and tactical improvements to these processes, and ensures compliance to all applicable laws, guidance, and regulations. Develops and sustains a long-term optimal structure and processes around emerging encounter data submission requirements; analyzing, monitoring, and planning key risk adjustment milestones and identifying improvement opportunities. The incumbent oversees the project management and business analysis functions for the Revenue Program Management division. Responsible for thought-leadership and project management expertise to facilitate the development of the department’s strategic plan, and to deliver key strategic initiatives and critical Program(s)/Project(s) within the constraints of scope, quality, time and budget. Directs the requirement development, testing and refinement of the underlying systems, defines strategic and tactical approaches to improve business systems to support the underlying workflow of these systems, and is a facilitator of the divisional planning process. Includes the oversight of staff that serve on Program(s)/Project(s) to deliver solutions for risk adjustment programs. Collaborates with stakeholders on project planning, risk mitigation, contingency planning and execution to ensure delivery of expected outcomes. Functions as the primary advisor of strategic direction on risk adjustment and collaborates and communicates with both clinical and operational executive management and external vendor partners.
LICENSES AND CERTIFICATIONS
Language (Other than English)
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Does Not Apply
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)
Does Not Apply
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.
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