Supervisor Measurement Reporting

Company :
Highmark Inc. Job Description :

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 Blue Star 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.

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.

Blue Star 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.

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 Blue Star system. Advanced understanding of…