Supervisor Risk Revenue

Job ID: J125150
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Jun 12, 2018

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Description

JOB SUMMARY

This job provides oversight of the Unconfirmed Diagnosis Program within the Risk Revenue Department.  The incumbent is responsible for the end-to-end process which includes intake from providers, supervision of coding functions, management of temporary production staff and on-going process improvement.  Reports to the Manager of Prospective Programs and works closely with Revenue Program Management Strategy Analysts to continuously implement procedure improvements and advance the market share of the Unconfirmed Diagnosis Program Program.

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. 
  • Create, maintain and communicate provider reimbursement and bonus model - this includes calculating payouts, accruing appropriate amounts and ensuring payout.   It also includes communicating the payout information.   Also responsible for the program budgets and PO process.
  • Supervises coding vendor contracts, implementing subsequent performance measures and administering/managing Service Level Agreements 
  • Develop and implement process improvement strategy to ensure the timely and accurate processing of Unconfirmed Diagnosis Code forms
  • Collaborate with Coding/Quality Team to ensure quality and completeness of coding protocols completed by Vendors.  Score vendors and provides feedback on quality to the vendors. Work through next steps with vendors when quality standard is not met
  • Act as secondary strategist on Unconfirmed Diagnosis Code program development and launch criteria. Reviews analytics and ensure criteria and logic are accurate.  Deliver program by specified implementation dates.  Liaison to Analytics Team for Program specifications
  • Provide timely reports to Revenue Program Management Team on Unconfirmed Diagnosis Code volume and completeness at the provider level.  Interpret reports and identifies potential opportunities for improvement.    Work with others across departments to develop and implement education or improvement plans.   
  • Other duties as assigned or requested.

EDUCATION

Required

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

Preferred

  • Master's Degree in Heath Administration

    EXPERIENCE

    Required

    • 5 - 7 years of Financial Reporting experience
    • 5 - 7 years of Healthcare Industry experience
    • 3 -5 years of Process Improvement experience
    • 3 - 5 years of Provider Communications experience

    Preferred

    • 3 -5 years of Risk Revenue experience

    SKILLS

    Required

    • Business Process Improvement
    • Financial Reporting
    • MS Word
    • MS Excel
    • Supervisory Experience

    Preferred

    • RFP
    • Contracts Management

    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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