"Alerted.org

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job supervises and coordinates the day-to-day activities of the UM Intake Coordination team. The incumbent selects, develops and continuously coaches staff to the highest levels of performance. Motivates and team builds through the creation of a work environment and conditions that contribute to highest levels of performance.

ESSENTIAL RESPONSIBILITIES

+ Perform management responsibilities including, but 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.

+ Determine workflow for the day and assign work to the team.Monitor and manage daily inventories to ensure adequate staffing and resources are available to ensure performance guarantees and established goals are met and maintained. Monitor calls for quality assurance and compliance.

+ Research quality issues and respond to error assessments. Maintain department logs and documentation, analyze for trends to identify and initiate future proactive measures. Produce and analyze reports through various systems and databases, focusing on productivity, quality and compliance.

+ Ensure compliance with all regulatory entities (i.e., DOH, CMS, NCQA, etc.) Create, implement, monitor and report on the policies and procedures to ensure all required business/compliance standards are met. Represent the department in compliance audits as it relates to the supervisor's functions.

+ Act as subject matter expert for benefit plan and claims processing

+ Research and investigate any privacy or compliance concerns (CMS, HIPAA, internal policy, etc.).Complete root cause analysis and address remediation process with impacted employees.

+ Participate in process improvement initiatives as appropriate, which may involve working across teams and with different levels of management.

+ Troubleshoot escalated cases, which may involve speaking with providers via phone.At times, build cases in Utilization Review system during high volume times.

+ May have responsibility for audit function and team members to audit workflow, process, and results. Analyze audit issues to determine root cause of errors and recommend process improvements. Review error trends to identify training opportunities.

+ Other duties as assigned or requested.

EDUCATION

Required

+ High School Diploma/GED

Substitutions

+ None

Preferred

+ Bachelor's Degree

EXPERIENCE

+ 5 years in Customer Service

+ 1 year in a leadership management

Preferred

+ None

LICENSES AND CERTIFICATIONS

Required

+ None

Preferred

+ None

SKILLS

+ Oral & Written Communication Skills

+ Telephone Skills

+ Problem Solving & Decision Making

+ Compliance

+ Healthcare Industry

+ Mentoring

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:

$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 [email protected]

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J272816