Job ID: J118815
Company: Highmark Health
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Mar 13, 2018
This job is the Subject Matter Expert (SME) over a business function (e.g. Claims, Service, Enrollment, Billing, Benefit Coding) and is accountable to ensure that the various audits of the function are compliant for each audit program or contractual requirement. The incumbent is accountable to proactively monitor all proposed and implemented operational and systematic changes that can impact the integrity of the audit processes and checklists for which they are accountable. The incumbent is engaged in BCBSA work-groups, notifications, and BlueWeb to ensure current understanding of audit program changes to ensure compliance and to weigh in to influence changes, where possible. Additionally, the incumbent will be engaged in Performance Guarantee and Statement of Work governance groups to stay current on changes and to offer appropriate recommendations, concerns and recommendations. Will coach and train audit staff on business and systems processes and prepare them for any changes. Will also stand up new and/or complex audits and complete until the effort is tested and seamlessly transitioned to front line staff. Will also serve as SME on complex or critical projects within the Audit & Compliance Division. Communicate effectively with management, steering committees, project sponsors, and subject matter/technical experts.
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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