Supervisor Performance Measurement Reporting

Highmark Health; Pennsylvania; Hybrid; USD 68,000 - 106,000; Full time

Job summary

Highmark Health is seeking a Supervisor Performance Measurement Reporting to oversee auditing, sampling and reporting across PMR operations including claims, customer service and enrollment.

You will lead staff, develop metrics, coordinate with operations, and drive quality improvements while ensuring HIPAA compliance and data integrity.

Qualifications

• Minimum High School Diploma/GED and 8+ years of auditing, quality function or operations management.
• Preferred Bachelor's degree in a business-related curriculum.
• Broad knowledge of claim, customer service and enrollment processes.
• Advanced knowledge of PMR process functionality and related interrelationships.

Responsibilities

• Oversee day-to-day PMR audit operations, including sampling, testing, and reporting.
• Lead or support BlueStar system projects and related testing.
• Develop and maintain audit methods, procedures, and data views.
• Recruit, train, mentor staff and manage performance reviews and staffing.
• Publish performance results and coordinate action with Operations.

Skills

Auditing

Quality management

Project management

Data analysis

Leadership

Communication

Mentoring

Education

High School Diploma/GED

Bachelor's degree in business-related curriculum

Tools

Lotus Notes

Excel

Word

BlueStar system

Job description

Company : Highmark Inc. Job Description :

GENERAL OVERVIEW

The Supervisor Performance Measurement Reporting provides day-to-day oversight and supervision of sampling, auditing, and reporting activities within Performance Measurement and Reporting (PMR) operations. The scope of responsibilities is broad based, covering claim, customer service and enrollment transactions. In addition the position is responsible for supervising all facets of the audit function, which includes, but is not limited to: promoting quality within the company; interpreting and applying quality program requirements and mandates and ensuring compliance; publishing performance results (internally and externally); and leading or supporting BlueStar system project activity. This position also ensures an effective Audit-to-Operations feedback loop and is responsible for administrative duties such as recruiting, training and developing of staff, mentoring and coaching, assessing performance and developmental needs, and contributing to the development of effective strategic and succession plans.

ESSENTIAL RESPONSIBILITIES

Ensure an effective Audit-to-Operations feedback loop, by providing specific and detailed audit results to management, thereby facilitating action by Operation’s in addressing/resolving any control or workflow weaknesses. Supervise PMR operations—oversees all activities related to day-to-day audit operations, which includes designing and maintaining statistical sampling plans, assigning and monitoring staff work, researching and interpreting audit requirements, resolving error disputes, and modifying audit methods, procedures, processes and protocols to accommodate changes in Operations and corporate technologies, etc. BlueStar system projects—this is a technical component of the job that involves leading or supporting system projects and activities related to the maintenance or development of Bluestar, relative to primary areas of responsibility. This includes developing project plans, requirements and specifications, designing formats, panels and data views, researching and resolving problems, requesting program or table changes or updates and conducting user testing, etc. Reporting—includes the compilation, tracking, trending, analysis and reporting of performance results. Staff development—this aspect of the job requires training, coaching and mentoring staff and participating in the succession planning process, as well as performing administrative duties such as recruiting, conducting performance reviews, approving and managing time and attendance, holding staff meetings, managing system accesses, etc. Other duties as assigned or requested.

III. QUALIFICATIONS

Minimum High School Diploma/GED 8 or more years of experience in auditing, quality function or operations management Preferred Bachelor’s degree in a business related curriculum 5 or more years of experience in auditing, quality control, or operations management Knowledge, Skills and Abilities Broad knowledge of company core operations with specific knowledge of claim, customer service and enrollment functions. Intermediate-level project management experience. Specific knowledge of claim adjudication, customer service, and enrollment processes and systems, as well as coding and billing protocols (ICD, CPT), reimbursement methodologies (Per Diem, Tier, PMC, DRG, UCR, etc.), medical policies and procedures, and other resource tools used by the company to support core operations. Advanced knowledge of PMR process functionality and relevant operational interrelationships. Advanced-level skills in using standard desktop applications such as Lotus Notes, Excel, Word, etc. Advanced-level knowledge of BlueStar system. Advanced understanding of quality measurement terminology and concepts as applied to PMR operations. Intermediate-level technical skills, as defined broadly in terms of abilities to: analyze data; research, interpret and assimilate data and information; identify and understand cause-and-effect relationships; define and frame issues; resolve problems; utilize IS tools; apply statistical sampling concepts and methods, etc. Excellent productivity skills, as defined broadly in terms of: abilities to: meet deadlines; make decisions and judgments; utilize resources; produce quality work; manage project activities, etc. Excellent management skills, as defined broadly in terms of abilities to: evaluate work of others, provide career and advancement coaching; delegate work assignments, provide leadership, etc. Solid communication and interpersonal skills, as defined broadly in terms of abilities to: communicate effectively; manage conflicts; use diplomacy; negotiate resolutions; work in a team environment, etc. Strong personal characteristics, as defined broadly in terms of attitude, corporation, creativity, dedication, dependability, ethical behavior, flexibility, initiative, professionalism, etc.

Language (Other than English): None

Travel Requirement: 0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely

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: $68,400.00 Pay Range Maximum: $105,900.00 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 any category protected by applicable federal, state, or local law. California Consumer Privacy Act Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.