Company :

Job Description :

GENERAL OVERVIEW:

This job serves as the primary negotiator for Single Case Agreements related to non-contracted entities, while also being responsible for facility/ancillary credentialing for the entire Allegheny Health Network. It maintains compliance with the No Surprises Act by reviewing and negotiating Qualified Payment Amounts, administering and serving as the subject matter expert (SME) for the Electronic Contract Repository, and maintaining Network Participation Tools for internal and external consumption.

ESSENTIAL RESPONSIBILITIES

• Negotiates and processes payor and employer single case agreements timely and accurately. Continually follows up on singe case agreements until complete and ensures compliance with terms of the single case agreement. Collaborates with Allegheny Health Network (AHN) Revenue Cycle and Managed Care team to ensure proper billing and timely follow-up on single case agreements. 40%
• Completes and submits facility credentialing and re-credentialing applications with all payors accurately and in a timely manner (including but not limited to hospital, ASC, and ancillary entities.) Resolves credentialing issues through collaboration with management, related departments, insurers and others as identified. Monitors and maintains key credentialing dates for all payors. 15%
• Manages Out-of-Network work queue and evaluates Qualified Payment Amounts. Ensures organizational compliance with No Surprises Act Requirements by negotiating single care agreements timely. 15%
• Administers the Contract Repository System and ensures that Managed Care Contracts are stored timely and accurately into Contract Repository system. Serves as primary intake for new contract documents and catalogs pertinent contracting language and events. Serves as department SME for Contract Repository System. 10%
• Maintains patient access matrix for internal consumption. Maintains and updates patient access matrix for external consumption. Collaborates with IT and Marketing to ensure timely updates to company websites. 10%
• Coordinates special projects and provides organizational support for the Managed Care department. Ensures that project deadlines are met and project documentation is maintained appropriately. 10%
• Other duties as assigned or requested.

QUALIFICATIONS:
Minimum

• Bachelor's Degree in Finance, Accounting, Business Administration, Economics, Statistics, or related field , or 6 years of progressive healthcare related experience as determined by the company in lieu of bachelor's degree
• 3 years of healthcare related experience
• Advanced computer skills using Microsoft Office (Word, Excel, and PowerPoint, Adobe, etc.)
• Substantial organizational skills, including multitasking and time-management
• Reliable customer service, follow-up, and communication skills
• Ability to work effectively both independently and as part of a team
• Continuously searches for process improvements to achieve accuracy and efficiencies
• Strong critical thinking, problem solving abilities, and attention to detail

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Preferred

• 1 year of Managed Care experience

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

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