Highmark Health Supervisor Risk Revenue in Pittsburgh, Pennsylvania

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

REQNUMBER: J125150

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