Highmark Health

Project Manager

• Responsible for successful planning, execution, and delivery of projects
• Develop comprehensive project plans including detailed schedules and resource allocation
• Allocate and manage project resources effectively
• Build and maintain relationships with key stakeholders
• Proactively identify and mitigate project risks and issues

Client Project Manager

Business Development Rep

• Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
• Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
• Oversees the development of the capital forecasting process and directs other forecasting and planning needs as appropriate. Prepares materials and agenda as well as conducts the AHN Capital Committee meetings.
• Oversees the establishment and implementation of processes, policies and procedures necessary to establish the annual capital budgets.
• Oversees the business planning and development function. Provide overall leadership and direction for all business cases including working closely with Highmark Health Strategic Transformation Office and senior executives to establish assumptions for volumes, market dynamics and financial metrics.
• Adhere to look-back analysis on all major capital spend items to test quality of assumptions and operating results according to approved capital plans.
• Demonstrates a high-level customer service focus by setting and adhering to high standards for self and others within the department for communication and maintaining positive relationships. Incorporates the needs and concerns of diverse constituencies into departmental decision-making processes.
• Interact with a wide array of internal and external customers at all levels of the business including finance, actuarial, cost and budgeting, membership and information technology departments to discuss model assumptions, model methodology and financial modeling findings.
• Support the Corporation's strategic planning efforts through the modeling of financial results to determine the financial targets by business segment that result in Enterprise's achieving the overall corporate objectives.
• The result of the modeling will be integrated with capital planning efforts which includes working with internal business units, treasury and others to understand the current risk composition of the of the Enterprise portfolio of companies to calculate risk adjusted financial returns under various scenarios.
• Communicate effective outcomes of model results using appropriate toolkit. Support analyst team on best communication strategies to aid them in articulating model outputs to Senior Leadership.

Director, Capital and Business Development Planning

Consultant

• Manage a book of business
• Assist with selling new to blue clients
• Serve as product expert for existing clients
• Deliver product implementation presentations
• Develop account specific marketing plans for key accounts

Client Advising Consultant

Data Specialist

• Investigate and resolve all assigned issues reported via E.HR work queues, user reported issues and patient reported issues in a timely manner.
• Assure the data and document quality and integrity of the E.HR by resolving identified problems.
• Researches, identifies and resolves documentation issues by performing chart correction/documentation processes necessary to ensure integrity of E.HR and associated databases.
• Collaborates with AHN departments to report and resolve issues as necessary.
• Processes incoming and outgoing mail and faxes in a timely manner according to established procedures.
• Provides support and education to all E.HR end users.
• Monitors and resolves any issues related to incoming or outgoing report distribution within the E.HR, ancillary and vendor databases.
• Produces accurate OR monitor.
• Performs other duties as assigned or required.

Data Integrity Specialist

Analyst

• Creates data-driven insights which identify actionable opportunities and/or create analytics and reporting solutions
• Supports and leads the design, development, execution, dissemination and interpretation of clinical and population health analyses, metrics and reports using clinical, member, financial and administrative data
• Establishes strong, collaborative and effective relationships and communication with internal and external clinical, administrative, operational, financial and technical stakeholders
• Serves as a strategic business partner to internal and external stakeholders as demonstrated by providing thought leadership and subject matter expertise

Senior Clinical and Population Health Analyst

Sales

• Provide timely and accurate responses to external customers.
• Resolve general account issues.
• Input data into processing systems to ensure work deliverables are free of errors and all relevant and complete information is included in final output.
• Perform sales support duties, including but not limited to: direct inquiries to appropriate Sales staff, analyze new and/or renewal submission request for completeness, enter data in sales system from source documents, follow up with Brokers/Producers/TPAs for missing information.
• Support and interact with multiple departments to ensure proper distribution and implementation of paperwork, binder checks, and maintains the daily activities/updates in applicable system.
• Obtain and process paperwork by thoroughly checking for missing information on the group application, enrollment applications, and any additional documents needed before account can be installed or paperwork can be sent to underwriting.
• Perform general office duties that may include: document management, ordering supplies, processing invoices, opening and distributing mail, making travel arrangements, assisting with facilities management.
• Other duties as assigned or requested.

Sales Support Coordinator

Social Worker

• Completes and documents psychosocial assessments and care coordination
• Provides crisis intervention to enhance patient/family coping mechanisms
• Engages in the discharge process to identify post-acute resources
• Provides education regarding psychosocial factors related to illness

Social Worker – Palliative Care

Program Manager

• Defines, prioritizes, implements, and delivers complex pharmacy programs
• Achieves program objectives within scope, quality, timeline, and budget
• Monitors and evaluates progress and financial health of projects
• Directs corrective action as needed to maintain program viability

Program Manager – Complex Pharmacy Programs

Care Coordinator

• Perform accurate and timely processing of pre-certification requests for authorization of medically necessary health care services
• Document, process and route requests for services
• Follow policies and procedures to assure case completion and compliance with state and federal regulatory agencies
• Maintain or exceed department standards for call volume, response time and related production and quality measures
• Communicate effectively and proactively inform designated individuals of the status of work assignment

Associate Care Management Coordinator

Human Resources

• Respond to inquiries and requests received from customers
• Deliver timely, professional and courteous responses to all customers on initial inquiries and transaction support and execution
• Provide courteous, respectful and reliable service to HR customers, including pre-hires, active and former employees and managers, and retirees
• Assess and resolve customer inquiries and issues (via phone, email and chat) or escalate to the next level
• Work with high quality and accuracy standards, capturing interactions within case management through case creation, update and closure
• Learn and understand HR functional area knowledge and navigate finding and using content within the knowledge base to resolve inquiries efficiently and accurately

HR Shared Services Customer Intake Specialist

• Execute operational, regulatory and compliance audits and advisory engagements
• Collaborate with team members to perform engagement planning activities
• Execute testing of entity level controls, process level manual controls, IT dependent manual controls and process level automated application controls
• Assist in the process to close-out and finalize audits/projects
• Collaborate with team and independent auditors in executing audit procedures and analyze, evaluate and enhance business process controls
• Communicate with customers, supervisors, and subject matter experts

Associate Internal Audit Analyst

Physician Assistant

• Facilitates effective diagnostic and emergency care for patients in both outpatient and acute inpatient settings.
• Proactively orders and interprets a comprehensive array of laboratory, advanced radiological, and specialized diagnostic studies to inform patient management.
• Independently institutes immediate emergency measures and stabilization techniques for acute patient situations, and ensures rapid communication with the attending physician or covering provider regarding any significant patient status changes or critical findings.
• Encompasses preparing and electronically prescribing a full range of medications, safely administering medications and injections; performing minor bedside surgical procedures; and executing complex specialty-specific procedures within specific environments.
• Actively coordinates complex care needs with patients, families, external community services, and the entire interdisciplinary team, initiating timely consultations with the attending physician for cases exceeding PA-C scope or requiring higher-level medical decision-making.
• Provides specialized care for patients in critical care and inpatient settings, ensuring all medical record documentation is accurate, complete, and timely to reflect the complexity of care provided in all environments.
• Educates patients and their families on health and illness prevention, medication, and treatment instructions, and recommend community resources as needed.
• Ensures seamless continuity of care and maintains highly effective communication across the entire care continuum, from outpatient visits to inpatient admissions and post-discharge follow-up.
• Institutes emergency measures, stabilize acute patient situations, perform hospital rounds, and communicate significant patient changes to the attending physician promptly.
• Engages in mandatory professional continuing education, participate in quality improvement initiatives, and ensure ongoing compliance with medical staff and organizational standards.
• Performs specialized procedures such as assisting in surgical procedures, interventional radiology, or fluoroscopic procedures under supervision, and contribute to the education of trainees and professional staff.
• Performs all other duties as assigned or required, including specialty-specific procedures and expectations as stated with privileging and job agreement.

Physician Assistant – Electrophysiology

Medical Assistant

• Under the direction of the provider and as a member of the health care team, assists in coordinating the examination, treatment and health care planning for patients.
• Assists with other office functions to support patient care and office operations.
• Follows all established protocols, policies, procedures and standardized workflows.
• Using the team based approach, assists in the coordination of patient care under supervision of the health care provider.
• Prepares and rooms patients within the clinical practice setting according to standardized work flows.
• Accurately obtains patient vital signs, documents patient information, patient history, tobacco, and medication screening.
• May assist in the administration of depression screening tools.
• Completes annual wellness visit screenings.
• Reviews, updates and screens medication list in the EHR.
• Reviews social history with patient and updates record.
• If applicable, pends/"cues up" orders for required age appropriate screenings, patient prescriptions, refills, or other orders based on AHN approved protocols.
• Performs back office testing following approved AHN protocols and policies.
• Assists providers with examination and procedures.
• May serve as a scribe with additional training.
• Provides follow up with patients at designated intervals via patient's preferred method (telephone, electronic, written) in accordance with provider instructions.
• Notifies patients of test results under the direction of provider in a timely manner.
• Prepares exam room for patient visit.
• Ensures adequate inventory of medical supplies.
• Ensures all patient treatment areas are at all times stocked with the appropriate supplies using established inventory standards.
• Cleans and sterilizes instruments per established AHN approved policy and manufacturer's guidelines.
• Accurately performs lab controls and equipment checks as assigned.
• Administers and accurately documents medications in accordance with policy and safe practice.
• Documents accurately in the electronic health record (EHR) according to established standards and work flows.
• Accurately performs clerical office functions and other duties as assigned.
• May require floating/travel between physician office locations.

Medical Assistant – Pulmonary

Billing Specialist

• Monitors and coordinates technical lab billing issues.
• Assists with day to day operational oversight of billing department and ensures daily duties are completed per established guidelines.
• Troubleshoots billing issues and takes appropriate actions.
• Assists customers with patient billing inquiries.
• Identifies unpaid balances (insurance and patient) through A/R reports and takes appropriate actions.
• Supervises work performed by billing staff.
• Maintains current knowledge of federal and state reimbursement policies/regulations and system policies.
• Ensures compliance with regulatory requirements.
• Obtains and enters patient demographic, insurance, and referral/precertification information in the billing system.
• Verifies insurance information via hospital and insurance carrier systems.
• Performs all other duties as assigned, including but not limited to supporting front end office processes.

Billing Coordinator

Systems Engineer

• Plans, designs/builds, tests, implements, and supports the needs of Epic Clindoc software.
• Analyzes and determines system requirements and specifications.
• Performs and documents workflow analysis while evaluating user experience.
• Supports and maintains environments or applications using domain knowledge.
• Creates and maintains documentation and training materials regarding the implementation of applications.
• Using knowledge of Epic, configures changes within the Epic environments to provide standardized, comprehensive workflows.
• Corrects issues, conducts routine maintenance, updates systems with new functionality to meet the end user's needs, and implements new technologies.
• Provides guidance and support to end-users to enhance the use of Epic, and offers solutions to resolve end-user system issues.
• Contributes to and manages small to medium projects independently.
• Updates stakeholders as appropriate on a timely basis regarding progress on assigned tasks, projects, and issues.
• Conducts problem-solving and root cause analysis to resolve routine to moderately complex problems.
• Identifies solutions and completes documentation.