Manager, Senior Products Revenue Management--Highmark--Pittsburgh, PA

Mike.Foster@rightthinginc.com for more details!!!

The Manager, Senior Product Revenue Management will oversee all analysis, process development and implementation to ensure that complete and accurate member information is submitted to CMS. The revenue received from CMS is member specific, based on health status and adjusted for various demographic factors. This information drives over $1.5 billion annual revenue, and must be verified and updated annually. The work of the revenue management area will increase Highmark M+C revenue by at least 45 million (3%) each year. The incumbent will oversee a team of Business Analysts that will identify opportunities for increased accuracy of the data submitted to CMS. The incumbent will facilitate cross-functional process development teams to develop appropriate provider communications, disease state management processes, member communications etc. to ensure appropriate CMS payment. The Manager will also ensure that the data is submitted in an accurate and timely manner to CMS in accordance to CMS regulation. The Manager is also responsible for information that will ensure accurate revenue projections in Highmark Financials.

The incumbent must possess strong analytical skills, excellent organizational and project management skills, strong team building skills and have a strong understanding of Medicare+Choice revenue structure, Highmark data structure and provider needs. The incumbent will formulate and execute strategies that will ensure accurate revenue from CMS under the CMS-HCC payment methodology. The incumbent must be able to effectively work with different levels of management/staff, participate in management/team meetings and assist in the development of M+C rate filings. The incumbent must be capable of directing a team, delegating assignments, providing technical guidance, overseeing and managing professional staff, completing yearly performance appraisals, conducting disciplinary actions as necessary, as well as participating in the hiring of prospective staffs.

 MINIMUM QUALIFICATIONS

• A Bachelors degree in or equivalent training in Business or Health Administration, Statistics or Finance is required.
• A Masters Degree in Business or Health Administration is preferred. Three to five years experience is preferred in Medicare with Five to seven years experience required in Health Insurance or Data Analysis.

Other qualifications, experience, and skills include:

To effectively fulfill the accountabilities of this position, The Manager, Senior Products Revenue Management, must have a strong background in data management and analysis, project management, ability to understand diagnosis information, M+C payment methodology, and provider incentive structures. The Manager must possess a highlevel of skill in leading interdepartmental and cross-functional strategy development. Excellent oral and written communication skills, as well as conceptual and analytic skills are necessary. Background in provider reimbursement and billing is necessary. Previous experience with CMS reimbursement, DxCG software is beneficial. Experience managing professional staff is required. Must be able to take charge of and account for management of staff working on multiple projects to ensure corporate deadlines and objectives are met.