Highmark Health

Manager

• Provides operational and financial oversight to a network of physician practices.
• Is responsible for improving office operational efficiency and productivity while providing cost savings and revenue enhancing services.
• Conducts on-site assessment of practice operations to identify opportunities for improvement in the areas of operational and process improvement, including patient access, care alignment, patient satisfaction, and maximizing revenue.
• Identifies barriers and implements corrective action measures to ensure positive outcomes.
• Develops, plans, and budgets on a strategic, tactical, and operational level for and with each practice.
• Manages and monitors key financial and revenue cycle metrics, including staff hours, resource allocation, expense budget, patient volumes, and the revenue cycle process.
• Supervises staff, resolves problems, and implements approved disciplinary action.
• Interviews, hires, trains, and conducts performance evaluations.
• Assumes day-to-day operations and oversight of employees of practice in the absence of the manager (i.e. leave of absence, resignation, etc.)
• Proactively manages physician contractual obligations by ensuring appropriate level of productivity (wRVUs), standardization of physician schedules and appointment times, and compliance with the 72-hour rule and same day availability for urgent patients.
• Manages all phases of onboarding in the practice acquisition process, including providing support to new managers and physicians, establishing processes, and site preparation.
• Manages all phases of exit process for departing practices, including medical records processing, site breakdown, and staff assignments.
• Trains new managers in policies and procedures.
• Provides ongoing guidance and support to established managers.
• Works constructively with all designated physicians, leadership, and health professionals to accomplish organization and practice goals.

Practice Manager, Regional – PCI

Systems Engineer

• Understand capability needs; Gather project specifications; Create business cases
• Translate high-level business needs into detailed requirements for new capabilities
• Analyze data to determine business problems, trends, or opportunities for process improvements
• Create/execute test cases; Provide root cause analysis and corrective action plans
• Ensure quality delivery
• Identify, document, and resolve risks, defects and issues
• Analyze market trends for competitive insight

Clinical Business Systems Analyst

Financial Planning and Analysis

• Responsible for the financial performance and operational forecasting and analysis at enGen
• Monthly financial reporting, strategic planning
• Direct oversight of Thryve subsidiary financial results, workforce analytics and spend forecasting
• Support to the CEO, CFO, CIO and leaders within the organization
• Support the Client Executive team in their oversight of external client relationships
• Key contributor to BOD and Rating Agency content
• Focus on business performance improvement and strategic priorities
• Systems administration for applications in managing key Finance functions
• Vendor management for all applicable vendors and communication
• Cloud Financial Operations oversight

Director, Finance

Support Engineer

• Overall administration and oversight of sales support activities for the sales office
• New and renewal processing, product implementation, vendor interaction, running reports
• Attend meetings with sales personnel
• Investigate and resolve complex issues
• Process and set-up new or updated clients in the appropriate system(s)

Sales Support Analyst

Analyst

• Deliver high-impact analytics and insights focused on Social Determinants of Health (SDOH)
• Support the development and evolution of enterprise SDOH dashboards and self-service analytic tools
• Serve as a consultative analytic partner to the Enterprise SDOH team
• Support advanced analysis of varied and multilevel data
• Develop insights that inform program design and strategic decision-making

Senior Clinical and Population Health Analyst – Social Health Analytics

Strategy

• Support executive leadership with a range of strategy activities essential to membership and margin goals.
• Provide analytical/strategic-thinking and leadership support to medical policy and utilization management teams.
• Manage major strategy projects with the help of internal or external strategy consulting resources.
• Serve as subject matter expert to Strategic Operations staff on membership, growth and operational strategy issues.
• Develop analytical frameworks and methodology best practices to analyze strategy issues.

Strategy Consultant – Medical Policy

Software Engineer

• Lead the design, development, and implementation of complex systematic solutions
• Analyze customer requirements, design robust architectures, code, test, and deploy solutions
• Maintain complex applications and ensure high service levels and quality standards
• Mentor less experienced team members

Senior Application Developer – Open Systems

• Drive the full lifecycle of medical policies, from initial development to publication and maintenance
• Leverage advanced data analytics to generate insights and develop reporting solutions
• Act as a primary owner of assigned medical policies, ensuring accuracy and clinical soundness
• Engage non-clinical teams to align operational guidelines with clinical policy intent
• Serve as a subject matter expert for internal and external customers

Lead Clinical and Population Health Analyst – Medical Policy

Medical Director

• Supports the Medical Policy team with expertise and knowledge
• Full-cycle ownership of commercial and Medicare Advantage medical policies
• Writing clinical criteria based on research
• Engagement of clinical and non-clinical team members for operational guidelines
• Address escalated inquiries from internal/external partners
• Conducts peer reviews as part of the quality review process
• Participates in various work-groups and sub-committees as a clinical lead/expert

Medical Director, Medical Policy

• Oversee and manage healthcare management analytics in the Medical Policy department.
• Develop and implement complex analytical, research, and decision support activities.
• Consult and provide analytical expertise for various projects related to Medical Policy.
• Manage hiring, coaching, and performance management of staff.
• Ensure timely delivery of all projects and initiatives.
• Establish vision and strategy for the analytics function.
• Stay current with industry best practices and tools in data visualization.

Manager, Healthcare Analytics – Medical Policy

Database Administrator

• Manage the day-to-day operation, maintenance, and performance tuning of on-prem SQL Server instances and databases
• Monitor, capacity plan, and optimize queries
• Install, configure, and patch SQL Server environments
• Maintain backup and recovery strategies to ensure data integrity and availability
• Monitor and maintain existing HA/DR solutions (e.g., Always On Availability Groups)
• Administer SQL Server security, managing logins, users, roles, permissions
• Diagnose and resolve database-related issues
• Maintain clear and comprehensive documentation for database systems and processes

Business Intelligence Analyst

• Collect, validate, analyze, and organize data into meaningful computerized reports
• Generate reports through mainframe and/or PC applications utilizing established applications/programs or developing new applications/programs
• Develop custom files/reports in mainframe and PC formats and/or applications
• Develop work plans to meet deadlines, accurately estimate completion dates and communicate status
• Resolve technical problems related to automated systems, perform analysis, develop and implement test plans and implement solutions

Senior Reporting Analyst

Claims Specialist

• Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed
• Provides counseling to clients and assists with client service programs
• Evaluates various claims submitted by Third Party Administrators (TPAs) for compliance with underlying policy provisions, federal and state regulatory guidelines, and industry standards
• Monitors, reviews and analyzes various complex potential claims
• Determines whether to pend or adjudicate claims following organizational policies and procedures
• Completes pended claim letters for incomplete, invalid, or missing claim information
• Identifies potential discrepancies in claim submissions
• Assists leadership with performing client performance evaluations
• Maintains accurate claim records

Senior Stop Loss Claims Analyst

Technical Product Manager

• Serve as a project leader for the definition, planning, and delivery of multiple large-scale product and technology projects
• Drive day-to-day operation of projects ensuring that all projects are reliably delivered on time, on budget and with a consistently high standard of quality
• Collaborate with all project stakeholders to proactively identify and mitigate project risks
• Determine communication strategies and execute those to provide accurate and timely project information
• Cultivate a customer-first attitude by forging relationships with stakeholders

Senior IT Project Manager, TPM, Software & AI Delivery

Medical Billing and Coding

• Deliver value to the Health Plan and beneficiaries enrolled in Risk Adjusted government programs
• Perform HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD)
• Analyze physician documentation and interpret into ICD10 diagnoses and HCC disease categories
• Build partnerships and work within coding teams and internal partners critical to HCC coding
• Provide recommendations for process improvements and efficiencies