Supervisor Provider Data Quality Management

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job manages a team of provider file representatives who are responsible for the system implementation of all provider contracts and provider demographics. Oversees an internal audit quality review program designed to ensure provider data accuracy and completeness, and to provide staff with feedback on their quality scores. Provides weekly management reports on quality, work-in-progress, volume trends and training opportunities. Responsible for training, updating departmental procedures, and ensuring consistent processes throughout the department.

ESSENTIAL RESPONSIBILITIES

Supervise non-exempt employees. Oversee internal audit/quality review program. Maintain and enforce departmental policies and procedures. Train staff. Meet internal and regulatory standards for timely data entry and report submissions and filings. Inventory Management Other duties as assigned or requested.

QUALIFICATIONS

Minimum High school diploma or GED 1 year of experience working with providers in areas such as enrollment and maintenance 1-2 years of experience with staff oversight and/or development, either in a formal or informal capacity Preferred 1 year of experience performing Medicaid and /or Medicare systems setup of provider contracts and provider demographics 3 years of experience in a provider data maintenance department of a managed care organization Inventory management of production work load Direct supervisory and/or management of staff (monitor day to day workloads, disciplinary reviews) Project management Skills Demonstrated behavior showing the ability to manage the work of others in a volume-driven environment Demonstrated work experience exhibiting strong business, analytical, judgment, and communication skills in a corporate environment Knowledge of claims and various provider contracting methodologies Understanding of software applications used Highmark Wholecare®, such as Managed Health Care System, CACTUS, OnBase Document Management and/or OnBase Workflow Ability to communicate effectively in oral and written form to a wide range of audiences representing a broad cross-section of intellectual abilities and interests

SCOPE OF RESPONSIBILITY

Does this role supervise/manage other employees? Yes, number of direct reports: 18 WORK

ENVIRONMENT

Is Travel Required?

No 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:

$62,700.00

Pay Range Maximum:

$97,200.00 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 Highmark Health is a national, blended health organization that includes one of America's largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health's 35,000 employees serve millions of customers nationwide through the nonprofit organization's affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health's businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.