Director, Provider Service

Job ID: J119186
Company: Highmark Inc
Location: Camp Hill, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Mar 14, 2018

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Description

JOB SUMMARY

This job is responsible for the overall service operation supporting the Organization's provider community of In-Network and out of network providers.  This includes support for digital inquiries, phone inquiries, web and other channels that providers may utilize to obtain service through Highmark.  This key leadership role handles servicing and completing end-to-end all service escalations from the provider community.  Partnering with the Provider Contracting and Provider account management team will be key and the incumbent establishes and maintains relationships with them to establish key strategies, align with the broader Organization objectives and prepare to execute other key strategies that may originate from the contracting or network team(s).  The incumbent directs and oversees site labor relations programs, policies, and procedures. Responsible for overall employee engagement, driving a culture of world class service, and ensuring employee recognition and reward programs align with our Core Behaviors and overall mission and vision. Develops strategic planning and goals that set appropriate targets of execution for work processes within the business unit to meet performance goals and drive strategic change.  

ESSENTIAL RESPONSIBILITIES

  • Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
  • Direct the daily production activities of staff member to deliver accurate, timely and efficient service to customers including establishing goals, monitoring performance, and delivering world class service.  Set goals, build the necessary scorecards and performance monitoring tools, and ensure the communication and transparency of key departmental results.
  • Establish a clear strategy to drive the overall effectiveness of the Organization's provider service function.  Create a culture of world class service and enhance/develop policies and procedures of the department that will improve the overall operation and service delivery.
  • Ensure all operational processes are in compliance with established quality standards, government and industry regulations, and client requirements. (If required: CMS Reporting) Accountable for CMS required reporting and operating a CMS regulated business in compliance with Medicare C&D regulations.
  • Develop and execute a hiring plan and overall growth strategy in partnership with the Command Center.  Ensure that high quality employees are sourced, hired and successfully onboarded and provide mechanisms and programs for coaching, mentoring, and overall career progression.  
  • Maintain and establish an experienced leadership team through the coaching, support, mentoring and training of direct reports in key leadership roles.  
  • Provide significant input and direction to the development of future operational capabilities by evaluating, investigating and recommending newly defined systems, process and techniques.  This should include identifying opportunities to drive operational efficiencies, automation and first call resolution.
  • Other duties as assigned or requested.

EDUCATION

Required

  • Bachelor's Degree in Business Administration/Management, Health Administration or Finance

Substitutions

  • 6 years of experience

Preferred

  • Master's Degree

EXPERIENCE

Required

  • 7 - 10 years in a Call Center
  • 5 - 7 years in Management

Preferred

  • 10 - 15 years in Customer Service
  • 7 - 10 years in Leadership
  • 3 - 5 years in Lean/Six Sigma

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.

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)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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