Company :

Highmark Health

Job Description :

JOB SUMMARY

This role is accountable for any program or strategic tactic to drive provider performance in the domains of provider technology and provider cost solutions and operations. Specifically, the incumbent will be responsible for the interoperability strategy between the enterprise and provider partners and will develop and multiyear roadmap eliminating duplicative capabilities across the enterprise today. Also, the incumbent will oversee the development and rollout of strategies to redesign a health system's cost structure and to reduce its administrative costs.

The incumbent is responsible for understanding regulatory trends and competitive advantages / disadvantages when formulating strategies. Accountable in any program design for the full business case including implementation strategy and working with rest of organization to ensure resources, technology, communications, training are in place. Programs should be ready to operationalize once transitioned. The incumbent will develop market rollout plans and roadmaps for the programs and will tie in enterprise and provider strategy into the creation of these programs.

ESSENTIAL RESPONSIBILITIES

• Develop and own the provider interoperability strategy and multiyear roadmap with ED&A, PHE, and enGen, eliminating duplicative capabilities that exist across the enterprise today.

• Lead the implementation roadmap for Epic Payer Platform (EPP) and Availity, and other future technology deployment and value realization initiatives. Identify next set of providers for given technology adoption and associated savings realization.

• Integrate strategic providers’ technology roadmaps with Highmark technology roadmap. Need to understand provider and Highmark technology landscapes and tools such as Epic Payer Platform (EPP), data feeds, Health Information Exchange, HEDIS Engine, Google Cloud.

• Develop and implement provider cost strategies, such as shared purchasing/services, payer-provider admin cost solutions, and shared risk capabilities, with the goal of reducing administrative costs at providers.

• Leverage a structured cost solutions opportunity assessment approach considering market conditions and capabilities to deliver provider cost repositioning.

• Oversee the team that works with CIO technology teams at strategic providers to organize and define a joint roadmap for data ingestion, interoperability, shared data repository, and path for solution prescription within EMRs for greater C2V value.

• Maintain market view of leading practices and unique cost structures in the industry.

• Assist in developing a value-based hospital model and method of best practice sharing across the community.

• Develop and maintain payment process simplification inclusive of cost reduction efforts across multiple provider networks.

• Maintain shared services programs between various providers.

• Oversee the shared risk capabilities, considering market conditions.

• Partner closely with team of leaders with expertise in reimbursement, member alignment, and provider transformation to develop and drive an integrated approach to each designated provider partner.

• 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.

• Other duties as assigned or requested.

EXPERIENCE

Required

• 10 years relevant experience in large, complex highly matrixed organization

• 7 years leadership experience

• 7 years of experience in IT, Business, Customer Relationship Management, or related field.

• 7 years in Finance and Accounting

• 3 years in Health Care Provider Operations

Preferred

• None

SKILLS

• Excellent communication skills and ability to sell roadmap/improvement ideas to a multiplicity of stakeholders across all lines of business.

• Expert industry knowledge with detailed understanding of complex data environments.

EDUCATION

Required

• Bachelor’s degree in business, Finance, Healthcare Administration, Information Technology or related field

Preferred

• Master’s degree

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel 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

No

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.

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.

EEO is The Law

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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Req ID: J238008