Job Information
Highmark Health Manager Reimbursement Operations in Jackson, Mississippi
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 HRServices@highmarkhealth.org
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Req ID: J278188