Company :

　　Highmark Inc.

　　Job Description :

　　JOB SUMMARY

　　This job is responsible for one or more of the following functions/responsibilities in support of a shared financial services division with the enterprise: Cash Receipt Processing, Cash Accounting and Reporting, Claims Overpayment Recovery, National Business Finance, Spending Account Processing, Financial Compliance Reporting units within the Finance division, all ASO Billing and Accounts Receivable Management for medical/dental claims activities, buy-up, shared savings, drug ERISA reporting, client reconciliation/Settlements of Non and Semi-Risk business and creation of customized customer ad-hoc reporting. Will provide both financial and operational services for Highmark Health entities including: The Health Plan and diversified businesses. This job manages a team responsible for the review of monthly journal entries and reconciliations, analysis, and oversight of the maintenance of related financial records.

　　ESSENTIAL RESPONSIBILITIES

　　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.

　　Project Management:Acts as business platform(s) owner for various Finance Systems and directs the daily operations of the underlying systems, supporting and contributing to strategic and tactical initiatives to improve these operations and systems, defines, enhances and/or supports the underlying workflow of these systems. Prioritizing work to be completed, approving business requirement, assisting with design, etc. are the responsibility of this position. Responsible for directing the identification of enhancements and expanded capabilities, as a means for reducing administrative costs of these major enterprise systems through direct facilitation with the technical, business and user community. Continual automation of processes, implementation of new technologies to improve controls and simplification wherever possible is key to this role. Identify and escalate business system defects or technical issues, as needed. Partners closely with the stakeholders, including commercial clients, IT and others who support and/or use the underlying systems and processes and provides data and knowledge used to service group customers, members and providers. Adhere to multi-state and federal government regulations, corporate policy mandates, compliance requirements and process improvement initiatives impacting systems. Manage corporate initiatives such as system or business migrations or enhancements, new product offerings, company integrations etc. impacting assigned processes. Lead staff to develop or enhance current processes to accommodate.

　　Effectively oversee and support the day -to-day financial operations and analysis of the Health Plan and diversified business: Manage the processing in Cash Accounting and Reporting to ensure the accurate reporting of the Corporation’s banking activity including funding, disbursement and lockbox accounts, Cash Accounting and Reporting. Complete all bank reconciliations, process stop payments, void, complete check copy requests, research check forgeries, and complete some manual check issues. Manage the processing of incoming cash receipts in Cash Receipt Processing area to ensure the proper handling of all non-premium related cash receipts. Manage the financial activity pertaining to Spending Account Processing. Included in this role is the accurate processing of provider payments for CDHP claims processed by the spend account vendor. Responsible for National Business Finance which concentrates on all of Highmark, Highmark DE and Highmark WV’s BlueCard activity. This area is responsible for proper accounting and reporting of all BlueCard activity, monitoring claim variances and interacting with Operations to ensure proper resolution. Review of monthly journal entries and reconciliations, analytical review and variation analysis and oversee the maintenance of related financial records, reconciliations, and analytical reports. Provide oversight and all maintenance of invoicing and premium collections for Highmark and provides direction of the collections, billing, new business, and rating method implementation. Manage the weekly/monthly analytical reporting of invoicing and A/R financial trending and oversee the maintenance of related financial records are fed appropriately to the General Ledger. Develop and implement internal controls for assigned processes and verify they are in place and operating effectively to meet MAR documentation standards. SARA Approvals and SRWT certifications are a required job function. The systems include Cash Management System, Manual Payments, T-RECS, UPCS, BlueMGIC, Claims Overpayment Recovery, Claims Billing System, Revenue Estimation Group Settlement, iMart and Corporate LAN Drives.

　　Proactively adapt to business and market changes by developing and managing activities required to ensure accurate, timely and efficient completion of financial operations.

　　Collaborates on strategic and tactical initiatives to ensure all financial impacts are evaluated and incorporated into business and technical solutions.

　　Plans, manages, and oversees the implementation of strategic business and functional infrastructure of the underlying systems that support subsidiaries, affiliates, and market segments, that rely on the finance business platforms.

　　Identifies business opportunities, short- and long-term solutions, create high level vision requirements and define expected outcomes, review and approve technical requirements, test cases, and production release management to ensure quality outcomes.

　　Manages successful outcomes on projects impacting assigned processes related to enhancements, expanded capabilities, system or business migrations, company integrations, new product offerings etc. that may span outside of the finance department.

　　Other duties as assigned or requested.

　　EDUCATION

　　Required

　　Bachelors degree in Accounting, Finance or BusinessSubstitutions

　　7 years of related experience in lieu of degree.Preferred

　　Master's degree in Business AdministrationEXPERIENCE

　　Required

　　5 years experience in Finance, Accounting, and/or Financial Analysis

　　3 years experience managing/leading staff and/or projects of varying size and complexity

　　Experience with various computer applications to include MS Excel and/or MS Access.

　　Experience utilizing an automated general ledger and consolidation package and/or various other data repositories.

　　Preferred

　　Experience in health insurance industry

　　Expert knowledge of Highmark’s operational and financial systems and reporting processes

　　LICENSES AND CERTIFICATIONS

　　Required

　　NonePreferred

　　Certified Public Accountant (CPA)SKILLS

　　Leadership skills and ability to relate to all levels of management and staff as well as external customers.

　　Ability to work in a fast-paced environment with daily work processing deadlinesStrong business writing and oral communication skills.

　　Ability to develop specific skills and a broader knowledge of all departmental functions as a subject matter expert.

　　Ability to think strategically and act proactively under pressure independently and as a part of a team.

　　Strong innovative problem-solving capabilities, ability to demonstrate forward thinking and make recommendations for resolution.

　　Ability to lead department and enterprise level projects.

　　Advanced negotiation and influencing skills.

　　Excellent team building and professional development skills.

　　Strong proficiency with Microsoft Office products (i.e. Word, Excel, PowerPoint, Outlook etc.)

　　Must possess an understanding of DB2 and Oracle table structures, batch processing, use of query tools, etc. is required and understand how these systems operate in conjunction with other Highmark Health Services' applications.

　　Must have knowledge in BCBSA policies and procedures and be able to respond to changes as they occur.

　　Expert knowledge of Highmark’s financial and operational systems including but not limited to billing, revenue, claims, supporting source systems, and general ledger including how these systems interact with each other during day-to-day operations and monthly reporting processes.

　　Expert knowledge of product structures to ensure product results are reflected appropriately in invoicing and A/R to facilitate financial analysis.

　　Language (Other than English):

　　None

　　Travel Requirement:

　　0% - 25%

　　PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

　　Position Type

　　Office-based

　　Teaches / trains others regularly

　　Occasionally

　　Travel regularly 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

　　Yes

　　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

　　Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

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　　California Consumer Privacy Act Employees, Contractors, and Applicants Notice

　　Req ID: J235787