Highmark Inc.
SupervisorProviderDataQualityManagement
“Supervisor Provider Data Quality Management at Highmark Inc.. Skills: process management, cross-functional coordination, vendor/stakeholder management, operational metrics, resource planning, continuous improvement, staff oversight, provider data quality management. 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”
What You'll Achieve.
ensure provider data accuracy and completeness; Meet internal and regulatory standards for timely data entry and report submissions and filings
Industry & Context.
analytical; judgment
adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies, compliance with HIPAA, compliance with data security guidelines, compliance with the company’s Code of Business Conduct, adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements
What They're Looking For.
Must Have
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
Nice to Have
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), Project management
What You'll Do.
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
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
How You'll Work.
Team & Collaboration
cross-functional coordination; vendor/stakeholder management
Communication Scope
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
Process & Methodology
Project management
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