Company :Highmark Inc.Job Description :JOB SUMMARYThis 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 responds to error assessments. Maintain department logs and documentation, analyze for trends in order to identify and initiate future pro-active 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 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.
Other duties as assigned or requested.
EDUCATIONRequired
High School Diploma/GED
Substitutions
None
Preferred
Bachelor's Degree
EXPERIENCE
5 - 7 years in Customer Service
1 - 3 years in a management role
Preferred
None
LICENSES AND CERTIFICATIONSRequired
None
Preferred
None
SKILLS
Oral & Written Communication Skills
Telephone Skills
Problem Solving & Decision Making
Compliance
Healthcare Industry
Mentoring
Language (Other than English):NoneTravel Requirement:0% - 25%PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONSPosition TypeOffice-basedTeaches / trains others regularlyOccasionallyTravel regularly from the office to various work sites or from site-to-siteRarelyWorks primarily out-of-the office selling products/services (sales employees)NeverPhysical work site requiredYesLifting: up to 10 poundsConstantlyLifting: 10 to 25 poundsOccasionallyLifting: 25 to 50 poundsRarelyDisclaimer: 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:$50,200.00Pay Range Maximum:$90,300.00Base 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 their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.EEO is The LawEqual Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migratedfiles/employers/posterscreenreaderoptimized.pdf )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 number below.For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.orgCalifornia Consumer Privacy Act Employees, Contractors, and Applicants NoticeReq ID: J252799