Manager Reimbursement Operations

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job plans, develops, and maintains operational processes and reporting related to group/provider facility and professional reimbursement configurations and other operational processes. Acts as the primary liaison between provider contracting, provider reimbursement, and claims experience. Collaborates with the pricing team to troubleshoot reimbursement issues and works with the Reimbursement Policy and Compliance team team to develop and maintain effective reimbursement quality programs and reporting.

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities to include, but are 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.

• Executes all reimbursement components of group/provider contracts and responsible for all associated status and issue reporting; serves as primary process input for provider contract execution for reimbursement.

• Plans, develops, and maintains operational systems, processes, and reporting related to group/provider facility and professional reimbursement configurations.Commits to ongoing process optimization and documentation of all applicable policies, procedures, and desk-level procedures.

• Serves as the primary enterprise liaison for provider reimbursement, including specially negotiated professional rates.Working with the pricing team, documents, troubleshoots, resolves, and reports all reimbursement issues and problems.

• Assists with the development and management of reimbursement compliance and quality programs.Develops and maintains all reporting, operational dashboards, and other reports associated with primary areas of responsibility.

• Other duties and special projects as assigned or requested.

EDUCATION

Required

• Bachelor's Degree in Healthcare Management or Business

Substitutions

• 6 years of related and progressive experience in lieu of Bachelor's degree

Preferred

• Master's Degree in Healthcare Management or Business

EXPERIENCE

Required

• 5 years in the Healthcare Industry

• 5 years with Reimbursement Operations

• 3 years in a Management or Leadership Role

Preferred

• 5 years in a Management or Leadership Role

• 3 years with Process Development and Optimization

• 3 years in Policy & Procedure Development and Enforcement

LICENSES or CERTIFICATIONS

Required

• None

Preferred (any of the following)

• Certified coder

• Lean Six Sigma Certification

SKILLS

• Knowledge of provider business and systems

• Ability to quickly identify and provide recommendations on issues and process improvements

• Strong organizational and time management skills with the ability to multitask and reprioritize

• Experience in team building, facilitation, negotiation and conflict resolution.

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

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.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$94,200.00

Pay Range Maximum:

$151,000.00

Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

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 any category protected by applicable federal, state, or local law.

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For accommodation requests, please contact HR Services Online at [email protected]

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Req ID: J278188