• Ancillary Provider Liaison

    Highmark Health (Pittsburgh, PA)


    Company :

    Highmark Inc.

    Job Description :

    JOB SUMMARY

    This job serves as a liaison between Highmark Health Plan and Highmark Home and Community Services (HCS). Must ensure HCS compliance to contracted Service-Level-Agreements. The incumbent must have an understanding of health plan needs to ensure HCS solutions meet the need of all Highmark service regions. Assesses how Health Plan changes to Product & Benefit Design, Network, Reimbursement, Medical Policy, Utilization Managment and Regulatory Requirements esnure HCS is aware and can help Highmark succeed in light of the changes.

    ESSENTIAL RESPONSIBILITIES

    + Collaborate with internal health plan and external enterprise owned/aligned stakeholders to develop Ancillary Provider/Post-Acute programs and strategies.

    + Serve as the Single-Point-of-Contact between Highmark Health Plan and HCS.

    + Successfully complete assigned projects by developing innovative, integrated solutions to resolve highly complex business issues.

    + Simultaneously leading multiple, large-scale, highly complex projects.

    + Other duties as assigned.

    EDUCATION

    Required

    + Bachelor's Degree in Business Administration/Management or Health Administration or relevant experience and/or education as determined by the company in lieu of bachelor's degree

    Preferred

    + Master's Degree in Business Administration/Management or Health Administration

    EXPERIENCE

    Required

    + 7 - 10 years of experience working in the Healthcare Industry

    Preferred

    + 3 - 5 years of Leadership experience

    + 3 - 5 years of Provider Relations experience

    + 3 - 5 years of Vendor Management experience

    LICENSES AND CERTIFICATIONS

    Required

    + None

    Preferred

    + None

    SKILLS

    + Analytical and Logical Reasoning/Thinking

    + Problem Solving & Decision Making

    + Communication Skills

    + Leading Change

    + Analysis of business problems/needs

    + Strategic Thinking

    + Strategic Relationship Building

     

    Language (Other than English)

     

    None

    Travel Required

    0% - 25%

     

    PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

    Position Type

    Office-Based

     

    Teaches / trains others regularly

     

    Travel regularly from the office to various work sites or from site-to-site

     

    Works primarily out-of-the office selling products/services (sales employees)

     

    Physical work site required

     

    Lifting: up to 10 pounds

     

    Lifting: 10 to 25 pounds

    Lifting: 25 to 50 pounds

    **_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.

     

    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 [email protected]

     

    California Consumer Privacy Act Employees, Contractors, and Applicants Notice

     

    Req ID: J273110