Now Hiring - Highmark Health - Ancillary Provider Liaison in Pittsburgh, PA

Company :

Job Description :

JOB SUMMARY

This job serves as a liaison between Highmark Health Plan and Highmark Home and Community Services (HCS) now knows as Helion. 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 Management and Regulatory Requirements ensure 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

Substitutions

• None

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 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.

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Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( [please apply online] )

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