Highmark Health Supervisor Provider Data Quality Management in Pittsburgh, Pennsylvania
Gateway Health Plan
Job Description :
This job manages a team of provider file representatives who are responsible for the system implementation of all provider contracts and provider demographics. Oversees an internal audit quality review program designed to ensure provider data accuracy and completeness, and to provide staff with feedback on their quality scores. Provides weekly management reports on quality, work-in-progress, volume trends and training opportunities. Responsible for training, updating departmental procedures, and ensuring consistent processes throughout the department.
Supervise non-exempt employees.
Oversee internal audit/quality review program.
Maintain and enforce departmental policies and procedures.
Meet internal and regulatory standards for timely data entry and report submissions and filings.
Other duties as assigned or requested.
High school diploma or GED
1 year of experience working with providers in areas such as enrollment and maintenance
1-2 years of experience with staff oversight and/or development, either in a formal or informal capacity
1 year of experience performing Medicaid and /or Medicare systems setup of provider contracts and provider demographics
3 years of experience in a provider data maintenance department of a managed care organization
Inventory management of production work load
Direct supervisory and/or management of staff (monitor day to day workloads, disciplinary reviews)
Demonstrated behavior showing the ability to manage the work of others in a volume-driven environment
Demonstrated work experience exhibiting strong business, analytical, judgment, and communication skills in a corporate environment
Knowledge of claims and various provider contracting methodologies
Understanding of software applications used Gateway Health Plan®, such as Managed Health Care System, CACTUS, OnBase Document Management and/or OnBase Workflow
Ability to communicate effectively in oral and written form to a wide range of audiences representing a broad cross-section of intellectual abilities and interests
SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees?
Yes, number of direct reports: 18
Is Travel Required?
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
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Req ID: J185136