Company : Highmark Inc. Job Description : 

JOB SUMMARY

This job is responsible for leading funding and billing operations for 3rd party administration, individual and business partner functions.  This position is responsible for motivating and cultivating a team to provide excellent service allowing for a consumer centric approach balanced with a cost competitive structure to achieve opportunities for additional business.  Assess systems, processes and people and make recommendations.  Define business requirements for software programs used to load, maintain, or transmit information.  Responsible for delegation oversight for subcontractors as well as communicating strategic direction and business requirements identification and post payment recoveries.  Review, document, and communicate software requirements to various vendors to ensure that both internal and external systems perform as required.  Work with multiple external entities to ensure that the vendor's eligibility data is accurate. Provide oversight and direction of the outsourced IS production center for each product line. 

ESSENTIAL RESPONSIBILITIES

Provide leadership and oversight of management for service operations.  Participate in the formulation and execution of the division’s service operations strategy and vision. Establish, monitor and work with team to continuously improve on all aspects of funding & billing operations.  Direct the daily production activities of team members to deliver accurate, timely and efficient service to customers.  Ensures accurate and timely updates to membership records. Ensure all operational processes are in compliance with established quality standards, government and industry regulations, and client requirements.  Accountable for CMS required reporting and operating a CMS regulated business in compliance with Medicare C&D regulations.  Work closely with other management areas to ensure operational consistency within the organization and all lines of business.  Provides direction, feedback and final approval on the setup of various systems to allow for accurate membership reporting and reconciliation.  Ensure high quality employees are hired for team and provide coaching, mentoring, and leadership to direct reports and team. Provide significant input and direction to the development of future operational capabilities by evaluating, investigating and recommending newly defined systems, process and techniques.  Direct and ensure that all budget guidelines are met.   Responsible for all aspects of the systems and processes to operate Plan Partner's business as well the membership data conversion, coordination with corporate systems, branding compliance for government required mailings, Service Level Agreements adherence and reporting, managing staffing in accordance with pricing model provided to Plan Partner and regulatory compliance. Other duties as assigned or requested.

QUALIFICATIONS

Minimum

Bachelor’s degree or relevant experience and/or education as determined by the company in lieu of bachelor's degree 7 years in large operations environment 7 years with insurance products principles, industry practices, and processes

Preferred

Master’s Degree 5 years of insurance product knowledge 5 years in workforce development and resource management 3 years with marketing or selling services for operational capabilities 3 years with project management

SKILLS

Experience to effectively manage, direct, and motivate staff. Demonstrated track record of operational effectiveness. Strategic thinking and planning. Must be willing to travel to meet with clients, attend conferences as well as assist Sales with site visits to potential clients. Financial and budget/expense management experience. Ability to handle multiple priorities and the ability to identify, analyze and solve problems independently. Strong organizational and analytical skills Ability to interpret and understand complex government regulations. Comprehensive knowledge of Medicare regulations, law and coverage issues.

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:

$108,000.00

Pay Range Maximum:

$199,800.00

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 their race, color, age, 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, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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