Company :Highmark HealthJob Description : 

JOB SUMMARY

This job supervises and coordinates the day to day activities inherent to the enrollment, membership, and billing functions for Medicare, individual, social mission, commercial, and partnership business.  The incumbent is responsible for ensuring the timely and accurate processing of member enrollment and billing transactions, assisting in audits conducted by internal and external entities, providing direction and instruction to team as well as overseeing the distribution of work.  Selects, develops and continuously coaches staff to the highest levels of performance creating a positive work environment that embodies the company core values.

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.Monitor work intake, productivity, and projects and assign work to the team accordingly. Monitor and manage inventories to ensure adequate staffing and resources are available to meet performance guarantees and established goals are met and maintained. Monitor to ensure quality assurance and regulatory compliance.Ability to analyze data, measure outcomes and develop action plans.  Ability to analyze data, measure outcomes and develop action plans.  Excellent written and verbal communication skills with ability interact with all levels of the organization; effective communication of data analysis, outcomes, complex process requirements and action plans to staff, corporate partners, etc.Identify, implement, and adhere to multi-state and federal government regulations, corporate policy mandates, corrective action plans, compliance requirements and process improvement initiatives impacting systems, operating platform and associated business processes and workflows.Serve as subject matter expert (SME) and liaison to various business units including Sales, Product P&Ls, Compliance, Government Agencies, Plan Partners, and HMHS.  Interact with all levels of management from the various business units. Lead problem solving sessions to solve complex problems that may arise. Writes and maintains department procedure documentation and all training materials.  Other duties as assigned or requested.Other duties as assigned or requested.

EDUCATION

Required

High School/GED

Substitutions

None

Preferred

Bachelor's Degree

EXPERIENCE

Required

3 years of membership, billing and enrollment or equivalent operational experience1 year of leading or supervising others

Preferred

3 years of Process Improvement

LICENSES or CERTIFICATIONS

Required

None

Preferred

None

SKILLS

Knowledge of multiple processing systems and workflowsAbility to interpret all government regulationsKnowledge of Highmark products

Languages (Other than English)

None

Travel Required

0% - 25%

PHYSICAL, MENTAL 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 position 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:

$50,200.00

Pay Range Maximum:

$91,200.00

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.

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 the email below.

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

California Consumer Privacy Act Employees, Contractors, and Applicants Notice