Highmark Health Manager PIM Provider Maintenance in Pittsburgh, Pennsylvania

Description

JOB SUMMARY

This job directs and manages the activities for the department. Responsible for the effective and efficient management of all activities, departmental applications and systems supporting corporate provider enrollment and demographic provider data maintenance. The incumbent is accountable for the leadership of key corporate operational provider data administration, management and reporting functions. Oversees responses to provider audits related to provider enrollment data warehousing, maintenance and reporting. Coordinates division projects, oversee business analyst for project management and provider department/corporate projects with oversight and provide subject matter expert support.

ESSENTIAL RESPONSIBILITIES

  • Ongoing maintenance and integrity of provider file and all sub-files and extract files.

  • Perform administrative and personnel activities.

  • Develop strategic and operational plans for department.

  • Implement effective quality control procedures and management reports, measure end improve processes on a routine/ongoing basis.

  • Support corporate initiatives, system changes to the provider file, transitions and other changes for the business unit.

  • Coordinate, participate and communicate divisional projects with Analyst support to management.

  • Communicate and coordinate essential activities with Provider Relations, Contracting, Compliance and external customers.

  • Other duties as assigned or requested.

QUALIFICATIONS

Minimum

  • High School diploma or equivalent

  • 3 years of experience personnel management

  • 3years of provider data management and operations experience

Preferred

  • Bachelor’s degree

  • Experience in basic contracting and credentialing

  • Claims Experience

  • Healthcare Experience

Skills

  • Experience leading or managing projects and related activities

  • Analytical orientation, expert problems solving aptitude

  • Healthcare compliance, CMS Regulations, NCQA, DOH, DOI, BCBSA experience

REQNUMBER: J122359

Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity