Highmark Health

Associate

• Process provider applications and re-applications including initial mailing, review, and loading.
• Maintain provider database and communicate with providers regarding credentialing status.
• Perform credentialing, re-credentialing and related activities and coordinate credentialing verifications.
• Review and process complex additions, updates and deletions of provider information.
• Train credentialing personnel in the use of various systems, software, databases and procedures.
• Participate in projects which streamline, automate or enhance credentialing functions.

Associate Credentialing Representative

Physician Assistant

• Facilitate effective diagnostic and emergency care for patients in both outpatient and acute inpatient settings
• Proactively order and interpret a comprehensive array of laboratory, advanced radiological, and specialized diagnostic studies to inform patient management
• Independently institute immediate emergency measures and stabilization techniques for acute patient situations
• Prepare and electronically prescribe a full range of medications
• Actively coordinate complex care needs with patients, families, and the entire interdisciplinary team
• Ensure all medical record documentation is accurate, complete, and timely
• Educate patients and their families on health and illness prevention
• Engage in mandatory professional continuing education
• Perform specialized procedures such as assisting in surgical procedures, interventional radiology, or fluoroscopic procedures under supervision
• Perform all other duties as assigned or required

Physician Assistant – Radiology

Product Manager

• Understand the department's and the company's strategic roadmap and competitive position
• Develop a holistic product vision and the corresponding product strategy to drive maximum value
• Actively anticipate future needs and utilize metrics and qualitative input to identify asset improvement opportunities
• Represent the product in all governance meetings
• Clearly set and communicate roadmaps, priorities, experiments, and decisions across audiences, from product team to executive levels
• Serve as accountable owner for the sets of products/tools within the designated portfolio
• Identify and drive both cross-product and cross-customer value and shared learnings
• Own the product backlog and use input from internal and partner teams to frequently refresh and re-prioritize the backlog
• Provide coaching and guidance to team members on product vision and strategic road mapping

Senior Product Manager

• Facilitate effective diagnostic and emergency care for patients
• Order and interpret laboratory and radiological studies
• Coordinate complex care needs with patients and families
• Educate patients and families on health and illness prevention
• Engage in mandatory professional continuing education and ensure compliance with standards
• Perform specialized procedures and contribute to the education of staff and trainees

Nurse Practitioner – Neurosurgery

Architect

• Designs, develops, implements, supports, and optimizes architecture strategy to meet business capabilities and needs
• Provides strategic consultation to business customers in defining or designing business processes, functions and organizational structures
• Participates in enterprise strategy development
• Specifies and designs large or complex systems, solutions, networks, infrastructure elements, or processes
• Reviews others’ system design to ensure selection of appropriate technology, efficient use of resources and integration of multiple systems and technology
• Establishes policy for selection of architecture components
• Provides advice on technical aspects of system development, integration, and processes
• Communicates effectively with all levels of organization
• Participates in customer walkthroughs and plans for design and technical walkthroughs

Revenue Operations

• Provide systematic daily support to numerous health system management teams within the Revenue Cycle.
• Supports the business, technical, and operational needs of the Revenue Cycle departments.
• Coordinate various aspects of project implementations, system upgrades, break/fix issues, training and quality assurance processes.
• Designs/builds, tests, implements, and supports the needs of Epic software related to Revenue Cycle workflows.
• Function as a liaison between Information Technology, systems vendors and Revenue Cycle departments.
• Communicates easily, accurately and confidently.

Revenue Cycle Operations Analyst

Risk

• Develop plans and manage activities in support of Risk Adjustment and Quality/HEDIS
• Direct daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS
• Assess viability of current direction/projects/operations and recommend strategies
• Implement strategic and tactical improvements to Risk Adjustment Coding and Quality/HEDIS processes
• Manage information to ensure accurate and efficient projects

Supervisor, Strategic Risk Adjustment and Quality

General Counsel

• Investigate factual situations and present creative solutions based on independent legal research and analysis
• Provide timely and accurate legal advice and prepare effective documents
• Oversee diverse litigation docket, drive litigation strategy, and provide counsel to internal stakeholders
• Analyze potential litigation exposure and respond to pre-complaint investigations and demands

Senior Counsel – Litigation

Human Resources

• Accurately perform day-to-day transactional and administrative processes
• Timely completion of fulfillment activities and customer inquiries
• Customer focused ongoing communication with current and former employees
• Conduct scheduled audits related to regulatory compliance
• Participate as a team member in the requirements, design, and testing of new systems

HR Shared Services Administration Specialist

Data Scientist

• Drive the development of innovative AI based solutions for enterprise stakeholders
• Translate business needs into AI solutions that align with strategic goals
• Design and build best-in-class AI and agent evaluation capabilities
• Deliver the analytical solution to complex business problems
• Document objectives, assumptions and processes

Senior Data Scientist – AI Services, Platforms

Systems Engineer

• Performs business analysis tasks by supporting stakeholders of a specific system application(s)
• Handles user inquiries/issues and enhancements to the system
• Works with stakeholders to identify solutions that may include training and process change
• Traces business requirements through to test plans and cases
• Develops experience and competence working closely with experienced colleagues

Associate Internal Business Systems Analyst

Onboarding Specialist

• Develop collaborative relationships across various departments such as sales, actuary, product, marketing and others, as identified.
• Actively collaborate with account managers, clinical sales consultants, and other key stakeholders in preparation for client meetings.
• Support sales when prepping for client meetings.
• Provide support for sales finalist meetings from a clinical services perspective by providing the clinical insight into value to members and clients.
• This is a client-supporting role.
• Support the clinical management team to assure that there are clear expectations for Case Managers & Disease Managers as it relates to specific models and client accounts.
• Provide new client implementation and ongoing support for clinical teams for buy-up products.
• Work with clinical managers to coach nurses on identified opportunities specific to client expectations.
• Serve as primary leader in coordination and preparation for client audits and clinical reviews assuring that all requirements established by the client including contractual obligations are met and staff involved in any onsite reviews are adequately prepared and coached.
• Work with the Member Listening System (MLS) team to align new cohorts or changes in existing cohorts to maintain contractual agreements.
• Liaison between Sales and Clinical teams to field sales and client requests for case management referrals, metrics and case escalations, and success stories.
• Analyze, synthesize, and provide clinical detail on High-Cost Claims & Authorization reports leveraging many systems and programs.
• Serve as the clinical subject matter expert for RFPs.
• Work with the clinical writing team to support the strategy in submissions.
• Manage the day-to-day performance operations for all Well 360 Products.
• Obtain, monitor and analyze data, monitor the performance of the buy-up models.
• Other duties as assigned or requested.

Clinical Client Integration Specialist

Data Analyst

• Support one or more analytical aspects of the business products and services life cycle
• Work with more senior team members, customers, Data Engineers, Data Architects, and Capability Managers to capture capability needs and drive quality data and reporting solutions
• Create and maintain deliverables such as data set creation, operational reports, and analytical dashboards
• Collaborate with cross-functional teams on data-driven projects
• Conduct requirement walkthroughs and sprint reviews
• Assure compliance for required standards and all necessary approvals have been obtained throughout the data delivery lifecycle

Associate Data Solutions Analyst

Project Manager

• Develop comprehensive project plans, including detailed schedules, resource allocation, budget management, and risk assessments.
• Proactively identify and mitigate potential project roadblocks.
• Define and manage project scope, ensuring all deliverables align with business objectives.
• Allocate and manage project resources (human, financial, and material) effectively to optimize performance and meet project deadlines.
• Build and maintain strong relationships with key stakeholders, communicating project progress, addressing concerns, and managing expectations.
• Proactively identify, assess, and mitigate project risks and issues, implementing appropriate corrective actions.
• Prepare and deliver comprehensive project status reports, maintaining meticulous documentation, including project plans, meeting minutes, project artifacts, and approvals.
• Lead and motivate project teams, fostering a collaborative and productive work environment.
• Implement quality control measures to ensure projects meet defined quality standards.

Senior Client Project Manager

Learning and Development

• Responsible for leading professional development for Care Management services across assigned areas of the health system
• Designs and evaluates onboarding, annual education, continuing education, and competency validation
• Collaborates with Care Management leadership and interdisciplinary teams
• Plans, develops, implements, and evaluates Care Management-focused educational and professional development programs
• Serves as an educational consultant to leadership and staff