Highmark Inc. Work Values

Daily Duties at Highmark Inc.:

*Collaborate with key internal stakeholders Quality Analytics , Performance Improvement, Medical Management, Provider Engagement and Contracting, Finance, and Compliance. *Monitor and analyze the effectiveness of risk adjustment programs, processes, infrastructure, and reporting, and make changes to improve results and effectiveness. *Identify, evaluate and implement new programs or modifications to existing programs and develop strategies to implement. *Collaborate with departments and vendors to ensure timely, accurate and complete submission of risk adjustment data to CMS and ensure reconciliation of plan payments. *Collaborate with internal departments and vendors to develop effective policies and procedures that ensure submission of risk adjustment data to CMS is timely, complete and compliant with CMS requirements. *In collaboration with internal departments as appropriate, develop and oversee the execution of strategies, programs and plans to engage contracted medical group physicians in proper assessment, coding and documentation of identified members, complete submission of data. *Develop and implement programs and educate providers on newly developed processes for proper medical record documentation. *Develop and oversee analysis of chart retrieval program including ROI, productivity, quality, risk score/ revenue impact at the plan and provider group level. *Utilize analysis to identify trends and opportunities for improvement, new strategies and further program development *Collaborate with leadership on the integration of retro prospective programs and promote the use of risk adjustment programs *Collaborated with vendors to project and monitor the impact of coding and chart retrieval programs on CMS revenue for budgets and plans *Coordinate and drive enterprise-wide risk adjustment initiatives. *Foster a comprehensive understanding of CMS guidance for risk adjustment policies and procedures within the department and with key stakeholders and providers. *Management of chart retrieval staff *Corporate Compliance Responsibility - As an essential function, responsible for complying with the Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, and policies.

What they like about Highmark Inc.:

A hiring company that offers alternative approaches to pay, performance bonuses, and/or equity in the firm is very attractive to you. You're generally less interested in working for an organization offering only traditional, salary-based compensation, one with limited opportunity to acquire equity in the firm, or one that does not actively promote skill development. In addition, you are more likely to choose a company that offers a variety of internal career options, with defined career paths. You view the learning of new skills and development of your expertise as key to your career advancement. These aspects of an organization may become even more important to you as you progress in your field, and are especially critical if you change career or occupation.

Tags

Acceptance Testing, Accounts Receivable, Applications, Billing, Budget Review, Budgeting, Business Analysis, Business Analyst, Financial, Financial Systems, Risk Revenue, Risk Adjustment, Strategy, Manager, Project Manager, Supervisor, Strategic Planning

Skills

Management, Project Management, Vendor Management, Microsoft office software products, Excel, Word, PowerPoint, Project, Visio, PowerShell, SharePoint, and Access, (Entry-Level) knowledge of SQL, SPSS, SAP, and Tableau software products, Risk Management, Operational Program Developement, Critical Thinker

These are some of the questions we asked our climbers about their experiences with Highmark Inc.: