[Hiring] Manager Contract Compliance and Payment Variance @Highmark Health

Role Description This job supports the Managed Care Department in contract negotiations, contract compliance, and reimbursement analysis. Collaborates with key stakeholders with regard to payor policies and revenue impact of payor expected reimbursement. • Perform management responsibilities including 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. (20%) • Manage all aspects of Managed Care related reporting including underpayments, reimbursement analysis, modeling analysis for negotiations and contract performance, and pay for value. (40%) • Provide direction and leadership to Managed Care staff. (15%) • Manage maintenance of the contract management system. (10%) • Administer negotiation of SCAs, payor credentialing, and vendor management. (10%) • Collaborate with Revenue Cycle, Finance, and other departments to provide information on payor policies, contract interpretation, and reimbursement analysis requests. (5%) • Other duties as assigned. Qualifications • Bachelor's degree in Finance, Business, or Healthcare Administration, or relevant experience and/or education as determined by the company in lieu of bachelor's degree. • 5 years in Health Care: Provider or Insurance. • 5 years in Financial Analysis. • 3 years in Healthcare Reimbursement. • 1 year in Leadership or Management. • Strong critical thinking, problem-solving skills and attention to detail. • Substantial organizational skills including managing multiple priorities. • Reliable customer service and communication skills. • Continuously searches for process improvements to achieve accuracy and efficiencies. • Proficient Excel capabilities. • Ability to analyze data, anticipate requests, and draw conclusions. Requirements • This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. • Employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. • Compliance with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures. • Compliance with the company’s Code of Business Conduct, including adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Benefits • Pay Range Minimum: $50.88 • Pay Range Maximum: $83.84 • 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.