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Technical Document Specialist -- Ricoh -- Chicago, IL

***Contact Mike Foster at mike.foster@rightthinginc.com or by phone at 610-263-3030 x: 4567 for more information***

Please Note:  This is for 2nd Shift:  Monday - Friday  3 pm - 11 pm

May do one or more of the following for high-end equipment (segment 5+), mastering in one or exhibiting competency in several areas: press operation, copier operation, bindery, fulfillment, QC, final check, pickup/delivery, facility maintenance, mailroom duties. Job Duties and Responsibilities Follows Ricoh Service Excellence performance requirements. Achieves customer satisfaction by consistently preparing, inspecting, compiling, and assembling projects accurately in a timely manner. Meets deadlines by working at a quick & steady pace while still maintaining quality/error free work. Achieves Time Productive statistics by meeting standards established by the facility. Meets company production standards by achieving at the Impressions Per Hour (IPH) rate in accordance with standards established by the branch. Demonstrates the ability to calibrate equipment by producing likeness in color and quality as required to match originals. Demonstrates the ability to transfer files electronically by sending files from the network to color equipment. Produces "error-free/perfect work" by demonstrating the operational knowledge of the use of the duplication equipment used in the location. Scans jobs and saves to tape by following the facilities electronic tape storage procedures. Maximizes print performance as workflow permits, by simultaneously performing a minimum of two functions on print equipment. Maintains optimal machine performance by correcting simple machine problems (clearing jams, refilling toner, replacing machine oil, etc.) and having a working knowledge of machine codes to report, in the event of equipment failure. Presents professional appearance to clients by dressing in a professional attire according to company standards. Ensures adequate time is scheduled for the completion of overnight work in production by assisting the Production Manager with the completion of an overnight plan. Validates the job scope of each customer order by using the "Look Deep Questions." Maintains a productive work environment by ensuring that the "Job Scheduling Board" is up-to-date reflecting declining hours and that the Orders In Staging Area is clean and organized. Meets company attendance standards by reporting to work punctually and working all scheduled hours and any required overtime. Organizes a "job" by validating job name and number, reading instructions on the Job Request Form and organizing supplies. Maintains skill level by scoring at a rate of 90% or higher on the Black and White Print Specialist Skill Review. Maintains skill level by scoring at a rate of 90% or higher on the Color Specialist Skill Review. Performs other duties as assigned.

Qualifications (Education, Experience and Certifications) Requires high school diploma or equivalent. Prefers minimum of 3 years of related experience in a high volume print/copy environment; previous experience using Xerox print/copy equipment is preferred. Requires intermediate or higher computer skill level, specifically using Microsoft Office applications (Excel, Word, etc.). Requires strong direct, face-to-face customer service experience. Requires strong communication skills (oral & written). Requires strong computer skills including knowledge of web-based software. Working knowledge of Planet Press preferred.   We are an Equal Opportunity Employer. M/F/D/V

RN Medical Policy Supervisor

E-mail mike.foster@rightthinginc.com for more information!

Highmark would prefer this candidate in Pittsburgh, PA but would also consider someone in Wilmington, DE, Camp Hill, PA, or Charleston, WV

• This position is responsible for monitoring, analyzing, comparing, and evaluating medical policy content and application for all Highmark products, and making recommendations, as necessary, to achieve objectives established by Highmark management.
• To this end, the incumbent must analyze a wide array of data, including Highmark policy application, procedure codes and modifiers, utilization, reimbursement, Blue Cross Blue Shield Association (BCBSA) policy/procedure codes, and other information, taking into account product differences, lines of business, and processing systems (e.g., OSCAR), etc. This requires coordination of information and activities with counterparts in Health Affairs, OSCAR Coding Solutions, Provider Relations, Senior Markets, Product Management, Regulatory, Compliance, Legal, and other external personnel.
• The incumbent is also responsible for supervising and directing a section of employees in the development and maintenance of medical policy used by the Corporation. This includes delegation of assignments, technical guidance, training, recommendations on personnel needs and preparation of performance appraisals including recommendations on performance ratings.
• In addition, the position has accountability for special projects and enhanced research activities within the department.
• To effectively fulfill the accountabilities of this position, the incumbent must demonstrate a thorough knowledge of medical policy, product lines, procedure codes, reimbursement, managed care, as well as a comprehensive understanding of medical terminology, BCBSA medical policy, Centers for Medicare and Medicaid Services (CMS) guidelines, the HCFA Common Procedure Coding System (HCPCS), International Classification of Disease (ICD) information, TeamSite, and Highmark and external processing systems.
• This position requires a thorough knowledge and understanding of the clinical aspects of the evaluation of new and existing medical technology.
• This requires skill in utilizing the Internet and various databases to do clinical research and analysis.
• The position also requires excellent analytical, problem-solving, decision-making, critical thinking, and verbal/written communication skills.
• In addition to sophisticated technical knowledge, the incumbent must demonstrate strong interpersonal skills and the ability to motivate and direct a professional staff.
• An R.N. degree is preferred, but not required.
• Some travel may be required.

REQUIRED QUALIFICATIONS:

Education level and/or relevant years of experience(s) in lieu of education:

• Bachelors degree
• Five (5) years combined experience in commercial claims and/or medical/surgical products or Medicare Advantage or Medicare Fee for Service program coverage

PREFERRED QUALIFICATIONS:

• Master's degree

Additional relevant knowledge and/or skills and/or work experience:

• Three (3) to five (5) years of experience in clinical research
• Ability to analyze CMS documents such as transmittals and the Federal Register
• Excellent verbal and written communication skills because of the interaction with various internal departments, as well as communications with physicians, state specialty societies, etc.
• Knowledge of OSCAR claims processing system
• Well developed computer skills using web search engines for clinical literature and clinical trials
• Independent assessment and excellent time management skills are necessary components of the multi-tasking accountability
• Excellent planning and organization skills
• Excellent critical/analytical skills
• Three (3) to five (5) years of supervisory experience
• Three (3) to five (5) years of project management experience

Additional relevant licenses, certifications, training, etc:

• Certified Professional Coder

Highmark is an Affirmative Action/Equal Employment Opportunity (AA/EEO) employer.

Senior Manager Consolidations & Reporting -- Ricoh -- West Caldwell, NJ

***Contact Mike Foster at mike.foster@rightthinginc.com for more information***

Responsible for ensuring all financial information for assigned functional area is in accordance with company policy, Generally Accepted Accounting Principles (GAAP) and Sarbanes-Oxley Act. Responsible for financial analysis of significant accounts, business segments and operating results from current quarter to prior quarter and to same quarter to identify key business drivers and areas of opportunity. Also, responsible for documenting accounting procedures, ensuring adherence to documented processes, and addressing any compliance gaps or internal control weaknesses for Sarbanes-Oxley certification.

JOB DUTIES AND RESPONSIBILITIES

• Identifies and Responds to Accounting Issues: Develops rationale for processes and communicates explanations. Provides information regarding accounting standards and processes to field operations as necessary
• Performs or ensures all accounting entries are completed accurately and timely for assigned accounting function or business units
• Delivers Results: Readily accepts new opportunities and takes appropriate actions to ensure the work is done; energizes others to achieve timely results; breaks down company-specific or customer's complex problems or situations into essential components and organizes resources to tackle the problem in a systematic way; sets expectations and empower others to come up with several possible causes for a problem and more than one solution option; demonstrates good judgment for which creative ideas and suggestions will work; facilitates discussions that generate creative solutions
• Analytical Skills: Understands multi-dimensional relationships: Identifies supplemental data requirements. Knows when it is necessary to drill down and obtain second and third level data. Targets needed information and discards irrelevant or information that is of a lower value. Analyzes relationships among multiple parts of a situation, problem, or issue. Validates the accuracy and integrity of data. Demonstrates a solid understanding of complex relationships. Interprets the implications of the data and makes recommendations based on sound analyses.
• Responsible for applicable balance sheet accounts. Ensures accounts are reconciled by designated workday and according to company policy. Reconciling items must be identified, properly supported, and resolved in a timely manner. Must be knowledgeable of system functionality and transaction processes to detect any accounting data anomalies, data corruption, or invalid data
• Improves Business Processes: Develops communication channels with internal and external customers regarding process improvement initiatives; recognizes and collaborates with key players in the improvement process and ensures critical processes and core technologies are mapped to the end customer; works within own and other functional areas to identify and remove internal and external barriers to process improvement; works with other managers to create measures for process efficiency and customer satisfaction; including determining root causes, establishing realistic goals and taking quick corrective action
• Sets Direction: Quickly separates the important from the unimportant and puts people and
• resources on the most important issues; Looks collectively at ideas and issues in light of their impact on the team, function/ area, and customers (internal and external) and makes adjustments to plans and resources accordingly; Interprets and analyzes data, issues and trends to adjust plans and/or effectively uses forecasts to adjust business plans
• Develops People: Develops accounting professionals and ensures company policies are adhered to in the performance of all assigned accounting tasks and addresses any compliance deviations and internal control weaknesses as they are discovered. Stays actively involved in the hiring and selection process to ensure that only qualified candidates are considered for open positions; assesses knowledge, skills and abilities of others to ensure talent is meeting the needs of the organization; arranges assignments, formal training and other experiences to foster direct report's personal learning and development; encourages direct reports to develop their own solutions to problems; confronts performance issues quickly and provides clear guidance and instruction to develop and improve job-specific skills; provides opportunities for others to learn from success and failure; works with others to implement change strategies that support the company's short and long term business strategies
• Provides internal and external auditors with requested client assistance including business process flow, financial process documentation, balance sheet account reconciliations, supplemental financial schedules, and fluctuation analysis for quarterly reviews and year-end audits
• Documentation: Documents accounting processes, assists in compliance testing, and resolves internal control gaps to meet control environment requirements for Sarbanes-Oxley
• Accountability: responsible for individual tasks assigned. Supports the efforts of others, shares best practices, and follows through on all responsibilities related to a change initiative or course of action
• Knowledgeable in Generally Accepted Accounting Principles (GAAP) for your area of responsibility and company policies and procedures
• Adheres to company policies (including company Code of Ethics) in the performance of all assigned accounting tasks and communicates any compliance deviations and internal control weaknesses to management as they are discovered

QUALIFICATIONS (Education, Experience and Certifications)

Typically Required:

• Accounting experience - 10 plus years Preferred
• Analysis experience - 6 plus years preferred
• Management experience - 6 plus years preferred
• Certified Public Accountant or Certified Management Accountant preferred
• College Degree in Accounting, Finance or IT, or equivalency required

HMO Reinsurance Underwriter -- Highmark (HMIG)

***Contact Mike Foster at mike.foster@rightthinginc.com for more information***

This position can be located in the Boston, South Miami, or Pittsburgh area!!!

This position will underwrite HMO Reinsurance and Provider Excess of Loss reinsurance business.

• The Underwriter will evaluate risks and underwrite using various forms of forecasting and rating techniques.
• The Underwriter will analyze and interpolate large amounts of medical claim data
• Underwriter will work closely with internal sales staff and external brokers
• Underwriter will work closely with internal departments such as Claims, Sales and Medical Management to resolve account specific issues
• Underwriter -- has responsibility for revenue growth and oversight of profitability for his/her underwritten reinsurance book of business 
• Major duties include rating, underwriting and monitoring performance of reinsurance accounts within underwriting guidelines. 
• In addition, the Underwriter is expected to actively participate in Departmental and Company wide projects and assume a support role to the Senior Underwriter
•  Underwriter is expected to actively interact with external producers.

 

REQUIRED QUALIFICATIONS

• Education level and/or relevant years of experience(s) in lieu of education:
• A Bachelors degree in or equivalent training in Business Administration or Mathematics
• Three (3) to five (5) years of experience Underwriting of group insurance products
• Three (3) to five (5) years of HMO reinsurance, Provider Excess Loss reinsurance, and Medical Excess reinsurance.

 

PREFERRED QUALIFICATIONS

 

• Strong analytic skills
• Excellent written and verbal communication skills
• Ability to properly evaluate and select risk 
• Problem solving skills
• Technical proficiency in rating and underwriting of reinsurance accounts 
• Strong Negotiation and organizational skills
• Highly proficient in Microsoft Excel and/or Access

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Actuarial Manager - Highmark - Pittsburgh, PA

E-mail mike.foster@rightthinginc.com for more information!!

SUMMARY OF JOB RESPONSIBILITIES

• This position is responsible for overseeing assigned actuarial staff and projects and working with the Corporate Actuary or Director in developing and implementing sound actuarial policies and practices to help Highmark meet its financial objectives. Incumbent is responsible for hiring and training actuarial staff.
• This position is also responsible for providing technical support for other areas such as Product Management & Development, Underwriting & Rating, and Sales.
• Actuarial Managers are expected to assist senior management decision makers by providing specialized reports and analysis of data on both a routine and ad hoc basis.
• This position is accountable for developing employees, preparing rate filings, providing actuarial support for financial forecasts, and monitoring financial results.

 REQUIRED QUALIFICATIONS

 Education level and/or relevant years of experience(s) in lieu of education:

• Bachelor's degree.
• 7 or more years of experience in the Actuarial field.
• 2 or more years of management experience and/or experience leading teams and/or projects of varying size and complexity.

 Other requirements (licenses, certifications, specialized training, physical abilities needed to perform the job):

• Attainment of the ASA (Associate) designation in the Society of Actuaries.
• Must be committed to pursuing actuarial exams and obtaining Fellowship in the Society of Actuaries.

PREFERRED QUALIFICATIONS

Additional relevant education level and/or years of experience:

• Bachelor's degree in Actuarial Science, Mathematics, or Statistics
•  Additional relevant knowledge and/or skills and/or work experience:
• Six (6) or more years of actuarial experience.
• Experience with Medicaid Pricing
• Ability to apply extensive knowledge of actuarial methods and procedures.
• Strong supervisory, communication, organization and project management skills.
• Demonstrated knowledge of the following actuarial proficiencies:
• In-depth knowledge of one or more of the following: premium rate calculations, required reserves, plan design, trend analysis, rate table construction, actuarial research, or systems development.

Additional relevant licenses, certifications, training, etc.:

• Completion of two FSA-level exam components
• Member of the American Academy of Actuaries

ESSENTIAL JOB FUNCTIONS

1) Communicate effectively. This position displays effective communication skills while performing the following functions:

2) Supervise entry-level and mid-level actuarial staff. (20%)

3) Develop pricing, strategy, and filings for the corporation's Medicaid business (30%)

4) Work with Underwriting and Rating, Sales and Product Management and Development to develop and implement appropriate rating strategies for group, direct pay or senior lines of business. Ensure that all strategies are in compliance with rate filings and applicable regulations. (20%)

5) Provide advanced support for the claim reserve process. (10%)

6) Provide assistance and risk management to the Product Management and Development area for pricing development of new products. Ensure that all new products are financially viable and stable. (10%)

7) Determine underlying factors impacting pure premium trends for various products and regions. Monitor trends for use in rating. Identify any shifts in trend and take appropriate pricing actions. (10%)

Oracle EBS Advisory Analyst, Marketing Systems -- Ricoh -- Malvern, PA (Philadelphia)

E-mail Mike Foster at mike.foster@rightthinginc.com for more information!!

***Must have Techno-Functional Oracle EBS experience***

Description

The Advisory Analyst is an expert/lead role in the CRM systems which works under the general direction of the Director/Sr Manager/Sr Technology Manager, Marketing, Pricing and Compensation systems and has responsibility over the sub area (Marketing) defined in the organization. This is an expert/Lead technical role with in-depth cross functional understanding of the application/business. This role works with business executives and end-users to roadmap application strategy, conceptualize new application projects, analyze business problems and document solutions that match the business needs and validate technical solutions. JOB DUTIES AND RESPONSIBILITIES * Provides in-depth application and functional expertise for Marketing systems including Web Systems, Ecommerce and Marketing automation * Coordinates cross functionally within IT and/or business functions to deliver projects on-time and within budget. * Assists a team of resources in delivering best in class solutions to business problems through the use of information technology. * Executes projects and initiatives in full compliance with defined processes and controls. * Coordinates cross functionally on complex projects. * Proactively recommends alternative IT approaches and approaches to business problems in the assigned area, consulting internally on technology challenges and system issues, and implements cross functional solutions. * Participates in the decision making process around technology strategy, conducts analysis on technical viability of solutions and provides guidance on delivery of complex projects. * Researches and maintains knowledge in emerging technologies and solutions to solve business problems. * Participates in, and often leads, business requirements sessions. Documents the business needs of the solution, as appropriate. * May also perform Requirements Analysis, Business Impact Analysis, High Level Design, Detailed Design, Problem Analysis, Customization design, Integration Testing, and System Testing and Support of the functional applications, as necessary and appropriate. * Prioritizes multiple tasks and projects, modifies and executes complex project plans and participates in plan implementation with little direction. * Performs other duties as assigned.

Requirements

* Bachelor's Degree in Computer Science, Information Technology, or other related field, or equivalent work experience * Typically has 7 to 10 years of IT and business work experience including managing team(s) in systems analysis functions. * Requires min of 4 years of experience with significant depth of knowledge in marketing automation software, Social collaboration, Salesforce.com, Web/Ecommerce systems and Content management systems. * Requires in depth understanding of digital/new media operations within a large scale organization We are an Equal Opportunity Employer. M/F/D/V

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Senior Internal Auditor -- Highmark -- Pittsburgh, PA

E-mail mike.foster@rightthinginc.com for more information!  

Ideal candidate will be a CPA with big 4 and industry experience!

Title	Sr Internal Auditor
Location	Pittsburgh, PA
Description	PRIMARY DUTIES AND RESPONSIBILITIES BUT NOT LIMITED TO: Conducting and coordinating the completion of multiple projects of varying size and complexity to evaluate internal controls, with a focus on financial, operational, and compliance risks on a corporate-wide basis, including subsidiaries. The audit projects include evaluation of: controls over and efficiency of internal business processes and procedures; controls to ensure compliance with applicable laws, regulations, and contractual obligations; third-party contractors engaged to perform significant services on behalf of the Company; and, special requests of executive and senior management and the Audit Committee. The projects are completed through a combination of work performed by the incumbent and supervision of less experienced professionals by the incumbent. The projects generally culminate with a written report that includes an independent evaluation of the design, effectiveness, and efficiency of the internal control systems established by management. In addition, the incumbent will be expected to provide counsel to management in the design and implementation of processes and controls. Some travel may be required, contingent on the specific assignments. Highmark is an Affirmative Action/Equal Employment Opportunity (AA/EEO) employer.
Requirements	REQUIRED QUALIFICATIONS: A Bachelors degree. A minimum of five (5) years of progressive experience in internal auditing, public accounting or a position where you worked with internal control design, documentation and testing is required. The auditing experience should be risk based and include knowledge of the COSO framework (Committee of Sponsoring Organizations' framework for assessing and maintaining a sound control environment) and Internal Auditing Standards. The incumbent must possess excellent oral and written communication skills to articulate internal control weaknesses, risks/impacts to the department and/or company and actions to address identified weaknesses to responsible management. The incumbent is expected to establish and maintain relationships with all levels of staff and management in a variety of departments and subsidiaries within Highmark and therefore must have excellent interpersonal skills and must be able to effectively resolve conflicts. The incumbent's projects are generally diverse in subject matter and objective and change annually based on the strategic objectives of Highmark and its subsidiaries. As such, the incumbent must possess substantial individual judgment, strong analytical and problem solving skills, sound business knowledge, and intuitive thought processes to understand the area under audit in a short period of time. The incumbent must be able to effectively apply those skills in assessing risks, developing and reviewing audit plans, developing and making recommendations to management and overseeing the work of professional staff. The incumbent must have the ability to use or recommend computer assisted audit techniques (CAAT) when developing audit test plans. The incumbent will be required to exercise professional judgment in the conduct of audits. The incumbent is responsible for facilitation of all project phases including initiation, audit plan development, testing documentation, issue development and reporting and follow-up on issue resolution. The incumbent must have excellent project management skills as they have accountability for management of multiple projects with often overlapping deadlines involving multiple departments. The position requires the ability to manage competing demands and the ability to work independently. Due to the nature of the work performed, the utmost integrity in discreet and confidential handling of confidential materials is expected. The position requires proficiency with Microsoft Office and Lotus Notes.  PREFERRED QUALIFICATIONS: A Bachelors degree in Accounting or Business Administration. An MBA, CPA, CIA or CISA is strongly preferred. A thorough knowledge of the operations and systems of Highmark and its subsidiaries is preferred. A general knowledge of health insurance, computerized management information systems, and governmental auditing standards would be beneficial.

Manager, Care Management - Highmark - Pittsburgh, PA

E-mail Mike Foster at mike.foster@rightthinginc.com for more information!!

Title	Manager, Care Management
Location	Pittsburgh, PA
Description	Summary of Job Responsibilities: The Manager of Care Management is an expert in the areas of utilization management, continuum of care planning, benefit interpretation, disease management, insurance industry regulations as well as personnel management. Accountable for the oversight; development and maintenance of the department's care management processes. This includes utilization management, strategic planning, care cost initiatives, system development and quality outcomes. Responsible for compliance to NCQA, URAC, CMS, DOH, and DOL regulations. Responsible for appropriate application of Medical Policy and criteria. A representative of Healthcare Management Services across the corporation. Coordinates all department activities; staff education, policy and procedure development and revision, care and case management audits, oversees overall operations such as call volume, referrals to case management, Blues on Call and physician advisor area. Expected to be a role model to staff and able to assist in the day to day activities as needed.
Requirements	Required Qualifications: High School Diploma 7-10 years experience in a managed care environment Clinical License Preferred Qualifications: Additional relevant knowledge and/or skills and/or work experience: 3-5 years in staff and project management Demonstrated Project Management skills. Excellent written and verbal communication skills. Ability to interact with all levels of the organization. Ability to interact with external customers and providers. Ability to analyze data, measure outcomes and develop action plans. Highly effective interpersonal skills. Recognized as a clinical nursing expert. Ability to intervene in crisis situations and multi-task. Excellent computer and software knowledge and skills.  Additional relevant licenses, certifications, training, etc.: Certification in Care Management Highmark is an Affirmative Action/Equal Employment Opportunity (AA/EEO) employer.

Clinical Team Manager--Highmark--Pittsburgh, PA

E-mail Mike Foster at mike.foster@rightthinginc.com for more information!!!

Title	Manager, HMS Clinical Team
Location	Pittsburgh, PA
Description	General Purpose:  Leads a team of licensed clinical professionals who deliver health coaching and case management services to Highmark members Accountable for daily operation of unit including staffing and scheduling to ensure that member outreach is effective and completed within defined timeframes and according to established processes. Ensures that team members are clinically competent and adequately trained in order to achieve member engagement targets as well as defined clinical and financial outcomes Establishes and monitors individual and team performance goals providing feedback and taking action to ensure that goals are achieved Leads/participates in work groups focused on continually improving the efficiency and effectiveness of the health coaching and case management services delivered to members Ensures on-going staff development through education and opportunities for professional growth  Highmark is an Affirmative Action/Equal Employment Opportunity (AA/EEO) employer. Required Qualifications: Bachelor's degree or equivalent training and experience Licensed clinical professional in the Commonwealth of PA or state of West Virginia 7 years of health-related work experience which must include either management/supervisory experience or experience leading/working on project teams Preferred Qualifications: Health or business-related Master's degree Certification in case management Experience in a comparable management role in a health-related setting Knowledge, Skills, and Abilities: Excellent interpersonal and communication skills Strong analytic skills with ability to interpret, evaluate and act on productivity, clinical and financial data Basic computer skills