Highmark Health

Company : enGen Job Description : JOB SUMMARY This role is an integral member of a technical team, responsible for supporting the design, development, and maintenance of the organization's data infrastructure, ensuring the efficient and reliable flow of data across various systems. This position is responsible for ensuring the reliable movement, transformation, and storage of data across various platforms. The incumbent will work closely with data professionals, analysts, and engineers to build and optimize data pipelines, ensuring data quality and integrity. The ideal candidate is adaptable, solution-oriented, and capable of collaborating across multiple teams to support a broad range of data initiatives. The incumbent and team will be involved in every aspect of the data process, from idea generation, analysis, design, build, and support, using the latest technologies and design patterns. ESSENTIAL RESPONSIBILITIES Design, develop, and maintain robust...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: The Operational Performance and Benchmarking Analytics Coordinator (OPBAC) role encompasses all activities required to measure our organization's performance relative to similar organizations in our industry. This includes collecting and submitting data and producing actionable reporting as supported by the Enterprise's benchmarking tool(s) for assigned entities and departments. The OPBAC is instrumental in ensuring that appropriate staff from within each facility provide and maintain essential data elements required to produce reliable and actionable data with each montly or quarterly submission. An understanding of hospital and clinical operations along with the utmost attention to the quality, integrity and completeness of data submissions are essential. Internal-facing responsibilities include creating awareness of the benchmarking process, serving as the direct contact for assigned...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: The Operational Performance and Benchmarking Analytics Coordinator (OPBAC) role encompasses all activities required to measure our organization's performance relative to similar organizations in our industry. This includes collecting and submitting data and producing actionable reporting as supported by the Enterprise's benchmarking tool(s) for assigned entities and departments. The OPBAC is instrumental in ensuring that appropriate staff from within each facility provide and maintain essential data elements required to produce reliable and actionable data with each montly or quarterly submission. An understanding of hospital and clinical operations along with the utmost attention to the quality, integrity and completeness of data submissions are essential. Internal-facing responsibilities include creating awareness of the benchmarking process, serving as the direct contact for assigned...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: The Operational Performance and Benchmarking Analytics Coordinator (OPBAC) role encompasses all activities required to measure our organization's performance relative to similar organizations in our industry. This includes collecting and submitting data and producing actionable reporting as supported by the Enterprise's benchmarking tool(s) for assigned entities and departments. The OPBAC is instrumental in ensuring that appropriate staff from within each facility provide and maintain essential data elements required to produce reliable and actionable data with each montly or quarterly submission. An understanding of hospital and clinical operations along with the utmost attention to the quality, integrity and completeness of data submissions are essential. Internal-facing responsibilities include creating awareness of the benchmarking process, serving as the direct contact for assigned...

Company : Highmark Inc. Job Description : JOB SUMMARY This job leverages combined people, process, and technology competencies to support large-scale, complex customer engagements; collaborates with various stakeholders (such as Product, Sales, Clinical, Provider and/or IT teams) and external entities to configure solutions and deliver value to customers; acts as subject matter expert and trusted advisor in solutioning, implementation, and/or executing of various business solutions and strategic capabilities for the supported Health Plans/customers; and works closely with engagement and leadership team to define strategic and tactical direction. The incumbent delivers value to customers through client-facing advisory and delivery services in support of HM Health Solutions and Health Plan product offerings and capabilities. Accountabilities include, but are not limited to, supporting deliverable content, engaging key customer stakeholders, providing analysis, and...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Evaluates and treats patients with injuries or diseases resulting in loss of physical or functional abilities; supervises work performed by support personnel; effectively communicates and collaborates with patients, families and members of the healthcare team. ESSENTIAL RESPONSIBILITIES: Performs initial and on-going assessments of patient's condition and establishes goals and plan of care which is appropriate to problems identified and involves the patient/family according to their capabilities and desires. Performs therapy interventions utilizing standard, and, possibly specialized, physical therapy techniques and skills as appropriate for the age and condition of the patient. Completes documentation to comply with department, hospital and regulatory standards. Participates in departmental initiatives for operational improvement, including committees and educational offerings....

Company : enGen Job Description : JOB SUMMARY This role is an integral member of a technical team, responsible for supporting the design, development, and maintenance of the organization's data infrastructure, ensuring the efficient and reliable flow of data across various systems. This position is responsible for ensuring the reliable movement, transformation, and storage of data across various platforms. The incumbent will work closely with data professionals, analysts, and engineers to build and optimize data pipelines, ensuring data quality and integrity. The ideal candidate is adaptable, solution-oriented, and capable of collaborating across multiple teams to support a broad range of data initiatives. The incumbent and team will be involved in every aspect of the data process, from idea generation, analysis, design, build, and support, using the latest technologies and design patterns. ESSENTIAL RESPONSIBILITIES Design, develop, and maintain robust...

Company : enGen Job Description : JOB SUMMARY This role is an integral member of a technical team, responsible for supporting the design, development, and maintenance of the organization's data infrastructure, ensuring the efficient and reliable flow of data across various systems. This position is responsible for ensuring the reliable movement, transformation, and storage of data across various platforms. The incumbent will work closely with data professionals, analysts, and engineers to build and optimize data pipelines, ensuring data quality and integrity. The ideal candidate is adaptable, solution-oriented, and capable of collaborating across multiple teams to support a broad range of data initiatives. The incumbent and team will be involved in every aspect of the data process, from idea generation, analysis, design, build, and support, using the latest technologies and design patterns. ESSENTIAL RESPONSIBILITIES Design, develop, and maintain robust...

Company : enGen Job Description : JOB SUMMARY This role is an integral member of a technical team, responsible for supporting the design, development, and maintenance of the organization's data infrastructure, ensuring the efficient and reliable flow of data across various systems. This position is responsible for ensuring the reliable movement, transformation, and storage of data across various platforms. The incumbent will work closely with data professionals, analysts, and engineers to build and optimize data pipelines, ensuring data quality and integrity. The ideal candidate is adaptable, solution-oriented, and capable of collaborating across multiple teams to support a broad range of data initiatives. The incumbent and team will be involved in every aspect of the data process, from idea generation, analysis, design, build, and support, using the latest technologies and design patterns. ESSENTIAL RESPONSIBILITIES Design, develop, and maintain robust...

Company : United Concordia Dental Job Description : JOB SUMMARY This job is responsible for screening, reviewing, evaluating online entry, correcting errors and/or performing quality control review and final adjudication of paper/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Reviews processed claims and inquiries to determine corrective action including adjusting claims as necessary and takes the corrective action steps using enrollment, benefit and historical claim processing information; may coordinate benefits and interact with customers. Responsible for the timely and accurate completion of claims adjustments which could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals, and system changes, etc.; provides technical assistance in researching and resolving inquiries. * Due to Department of Defense (DOD) contract requirements,...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: The Operational Performance and Benchmarking Analytics Coordinator (OPBAC) role encompasses all activities required to measure our organization's performance relative to similar organizations in our industry. This includes collecting and submitting data and producing actionable reporting as supported by the Enterprise's benchmarking tool(s) for assigned entities and departments. The OPBAC is instrumental in ensuring that appropriate staff from within each facility provide and maintain essential data elements required to produce reliable and actionable data with each montly or quarterly submission. An understanding of hospital and clinical operations along with the utmost attention to the quality, integrity and completeness of data submissions are essential. Internal-facing responsibilities include creating awareness of the benchmarking process, serving as the direct contact for assigned...

Company : enGen Job Description : JOB SUMMARY This role is an integral member of a technical team, responsible for supporting the design, development, and maintenance of the organization's data infrastructure, ensuring the efficient and reliable flow of data across various systems. This position is responsible for ensuring the reliable movement, transformation, and storage of data across various platforms. The incumbent will work closely with data professionals, analysts, and engineers to build and optimize data pipelines, ensuring data quality and integrity. The ideal candidate is adaptable, solution-oriented, and capable of collaborating across multiple teams to support a broad range of data initiatives. The incumbent and team will be involved in every aspect of the data process, from idea generation, analysis, design, build, and support, using the latest technologies and design patterns. ESSENTIAL RESPONSIBILITIES Design, develop, and maintain robust...

Company : enGen Job Description : JOB SUMMARY This job supports one or more analytical aspects of the business products and services life cycle, within a sub-product scope (one or more data components). Uses minimal judgement and discretion to assist in collaboration with customers to understand data, reporting, and analytical capability needs, gather project and data specifications, create data sets, operational reports, and analytical deliverables, translate high-level business data needs into detailed requirements for new capabilities (and change request/enhancements on existing capabilities), analyze data to determine business problems, trends, or opportunities for process improvements, create/execute test cases, provide root cause analysis and corrective action plan, verify delivery of customer data needs, and ensure quality delivery. Also supports identification, documentation, and resolution of risks, defects and issues. May analyze market trends for...

Company : United Concordia Dental Job Description : JOB SUMMARY This job is responsible for screening, reviewing, evaluating online entry, correcting errors and/or performing quality control review and final adjudication of paper/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Reviews processed claims and inquiries to determine corrective action including adjusting claims as necessary and takes the corrective action steps using enrollment, benefit and historical claim processing information; may coordinate benefits and interact with customers. Responsible for the timely and accurate completion of claims adjustments which could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals, and system changes, etc.; provides technical assistance in researching and resolving inquiries. * Due to Department of Defense (DOD) contract requirements,...

Company : Allegheny Health Network Job Description : Job Description Emergency Department: Level 2 Trauma unit with 34 beds, 2 trauma bays and 2 resuscitation rooms. We are the designated OB trauma center in Pittsburgh. At AHN , employees trust working together and place patients at the center of all they do. This 9 Hospital system, a part of Highmark Health, is transforming the future of healthcare by providing highly effective services to customers, patients and communities. AHN has commitment and dedication to being inclusive, valuing fresh perspectives, and offering the best growth and educational opportunities to employees. Forbes Hospital is a 315 bed, Level II trauma hospital located in the community of Monroeville. Our hospital offers the service lines of a city hospital, inclusive of trauma, neurosurgery, cardiothoracic surgery, interventional cardiology, obstetrics and psychiatry, while also building relationships across the organization in a...

Company : United Concordia Dental Job Description : JOB SUMMARY This job is responsible for screening, reviewing, evaluating online entry, correcting errors and/or performing quality control review and final adjudication of paper/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Reviews processed claims and inquiries to determine corrective action including adjusting claims as necessary and takes the corrective action steps using enrollment, benefit and historical claim processing information; may coordinate benefits and interact with customers. Responsible for the timely and accurate completion of claims adjustments which could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals, and system changes, etc.; provides technical assistance in researching and resolving inquiries. * Due to Department of Defense (DOD) contract requirements,...

Company : Highmark Inc. Job Description : JOB SUMMARY This job leverages combined people, process, and technology competencies to support large-scale, complex customer engagements; collaborates with various stakeholders (such as Product, Sales, Clinical, Provider and/or IT teams) and external entities to configure solutions and deliver value to customers; acts as subject matter expert and trusted advisor in solutioning, implementation, and/or executing of various business solutions and strategic capabilities for the supported Health Plans/customers; and works closely with engagement and leadership team to define strategic and tactical direction. The incumbent delivers value to customers through client-facing advisory and delivery services in support of HM Health Solutions and Health Plan product offerings and capabilities. Accountabilities include, but are not limited to, supporting deliverable content, engaging key customer stakeholders, providing analysis, and...

Company : United Concordia Dental Job Description : JOB SUMMARY This job is responsible for screening, reviewing, evaluating online entry, correcting errors and/or performing quality control review and final adjudication of paper/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Reviews processed claims and inquiries to determine corrective action including adjusting claims as necessary and takes the corrective action steps using enrollment, benefit and historical claim processing information; may coordinate benefits and interact with customers. Responsible for the timely and accurate completion of claims adjustments which could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals, and system changes, etc.; provides technical assistance in researching and resolving inquiries. * Due to Department of Defense (DOD) contract requirements,...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Provides distributive pharmacy services, assistance and support for the registered pharmacist. ESSENTIAL RESPONSIBILITIES: Processes medication orders including computer order entry, medication preparation and assembles all items prior to pharmacist final check. (25%) Maintains pharmacy inventory and supplies according to established policies and procedures, including inspection of assigned areas and use of pharmacy computer systems. (25%) Provides customer service by taking patient’s prescriptions and documenting all required information, handles all customer interactions in a courteous and efficient manner, and releases medications required by policy/procedure. (25%) For Outpatient Techs: Validates Medicaid, Medicare, or commercial insurance drug coverage and ensures adjudication is complete addressing any error messages, plus handles cash, prepares deposits and accounting...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Provides distributive pharmacy services, assistance and support for the registered pharmacist. ESSENTIAL RESPONSIBILITIES: Processes medication orders including computer order entry, medication preparation and assembles all items prior to pharmacist final check. (25%) Maintains pharmacy inventory and supplies according to established policies and procedures, including inspection of assigned areas and use of pharmacy computer systems. (25%) Provides customer service by taking patient’s prescriptions and documenting all required information, handles all customer interactions in a courteous and efficient manner, and releases medications required by policy/procedure. (25%) For Outpatient Techs: Validates Medicaid, Medicare, or commercial insurance drug coverage and ensures adjudication is complete addressing any error messages, plus handles cash, prepares deposits and accounting...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Optimizes patient care by promoting rational, safe and cost effective pharmaceutical care including drug dispensing, intravenous admixture program and providing drug information. Conducts drug therapy monitoring and implements drug therapy interventions to reduce adverse events. Oversees the work performed by pharmacy technicians, students and other support staff. ESSENTIAL RESPONSIBILITIES: Process prescriptions: Conducts prospective drug review on all prescriptions processed. Independently reviews and assesses medication prescriptions to identify, prevent and resolve potential and actual drug related problems; ensures that medications are accurately and efficiently compounded and dispensed. Ensures safe and appropriate and cost-effective medication therapies for patients. Demonstrates sound professional judgment and knowledge to resolve emergent issues. (20%) Drug Information and Patient...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job optimizes patient care by promoting rational, safe and cost effective pharmaceutical care including drug dispensing, intravenous admixture program and providing drug information. Conducts drug therapy monitoring and implements drug therapy interventions to reduce adverse events. Oversees the work performed by pharmacy technicians, students and other support staff. ESSENTIAL RESPONSIBILITIES: Process prescriptions: Conducts prospective drug review on all prescriptions processed. Independently reviews and assesses medication prescriptions to identify, prevent and resolve potential and actual drug related problems; ensures that medications are accurately and efficiently compounded and dispensed. Ensures safe and appropriate and cost-effective medication therapies for patients. Demonstrates sound professional judgment and knowledge to resolve emergent issues. (20%) Drug Information and...

Company : enGen Job Description : JOB SUMMARY This job supports one or more analytical aspects of the business products and services life cycle, including capability enablement with cross-team dependencies within a product scope. Uses significant judgement and discretion to collaborate with customers on complex data and reporting issues in order to understand capability needs, gather project and data specifications, create data sets, operational reports, and analytical deliverables to translate high-level business needs into detailed requirements for new capabilities (and change request/enhancements on existing capabilities), analyze data to determine business problems, trends, or opportunities for process improvements, create/execute test cases, provide root cause analysis and corrective action plan, verify delivery of customer needs, and ensure quality delivery. Also responsible for identification, documentation, and resolution of risks, defects and issues....

Company : enGen Job Description : JOB SUMMARY This job is responsible for configuring, rolling out, and supporting the Epic Resolute Hospital Billing and Claims application. Responsibilities include business/systems analysis, requirements definition and documentation, system design, and problem resolution. The analyst communicates with system end-users to understand issues and implement solutions.? ESSENTIAL RESPONSIBILITIES Plans, designs/builds, tests, implements, and supports the needs of Epic software. Analyzes and determines system requirements and specifications. Performs and documents workflow analysis while evaluating user experience. Supports and maintains environments or applications using domain knowledge. Creates and maintains documentation and training materials regarding the implementation of applications. Using knowledge of Epic, configures changes within the Epic environments to provide standardized, comprehensive workflows....