Jobs at Highmark Health

Configure, roll out, and support revenue cycle applications (primarily Epic). Perform business/systems analysis, requirements definition, testing, troubleshooting, and stakeholder communication to optimize revenue cycle workflows and drive continuous improvement.

Support and learn to implement and operate mainframe storage hardware and software. Assist with day-to-day storage operations, production monitoring, incident/change management, documentation, and on-call rotation. Collaborate with stakeholders and architecture, perform technical analysis, and follow standards and processes to deliver reliable enterprise storage solutions.

Conduct and manage investigations into suspected provider, member, facility, pharmacy, group, or employee fraud, waste, and abuse. Develop and maintain the anti-fraud program, deliver training, perform audits and field investigations, coordinate with law enforcement and internal committees, and support recovery of improper payments. Prepare reports, refer cases as needed, and ensure regulatory compliance.

The role involves leading the data governance team, managing IT projects, collaborating with stakeholders, and ensuring continuous improvement of processes. Responsibilities include strategic planning, client management, and optimizing resource utilization, while overseeing governance activities and departmental management.

Lead formulary and utilization management strategy by monitoring approvals and pipelines, writing drug monographs, and implementing prior authorization and utilization policies. Ensure regulatory compliance, partner with analytics and vendors for real-world evidence, develop education initiatives, manage projects and process improvements, and mentor junior staff.

The Senior Accountant manages financial transactions, prepares financial statements and reports, provides analysis, and mentors junior staff while undertaking various accounting tasks.

Manage post-award financial activities for grants, contracts, and clinical trials including award setup, invoicing, cash management, month-end close, financial reporting, compliance, project closeout, audit support, and analysis to ensure GAAP and sponsor regulation adherence.

Lead end-to-end strategic projects to optimize health plan programs, perform data-driven analyses, build impact models, present executive recommendations, advise cross-functional stakeholders, mentor junior analysts, and monitor initiative outcomes to improve efficiency and care quality.

Supervise and support coding staff, manage workflow, scheduling, and productivity; provide technical coding expertise (ICD-10-CM/PCS, CPT/HCPCS); assist manager with payroll, training, physician education, and special projects; analyze coding data and recommend process improvements to optimize revenue cycle performance.

Manage and direct Risk Adjustment coding and Quality/HEDIS operations, oversee audits and provider outreach, implement process improvements, ensure regulatory compliance, coach staff, and coordinate cross-functional initiatives to improve documentation, coding accuracy, and quality measures.

Provide senior legal counsel and litigation oversight for healthcare matters, focusing on provider-payor disputes, fraud, privacy, and antitrust. Manage outside counsel, supervise discovery and trial prep, analyze exposure, coordinate risk with compliance and governance, mentor legal staff, and advise business stakeholders on statutory, regulatory, and contractual issues.

Perform HCC and ICD-10 coding for Medicare Advantage, ACA, and ESRD projects, support RADV and regulatory audits, analyze physician documentation for risk adjustment, educate providers, and recommend process improvements to ensure coding accuracy and CMS compliance.

Provide front-line guidance for pharmacy call center operations: review prior authorizations and non-formulary requests, communicate with physicians and pharmacies, document decisions in OnBase and Argus IPNS, ensure regulatory turnaround times, and support staff workflow and appeals.

Lead Financial Analyst conducts financial and business research and analysis, prepares forecasts and reports, develops and maintains spreadsheets/databases, leads financial analysis projects, presents findings to management, coordinates cross-departmentally, explains variances, and recommends improvements.

Lead design and delivery of generative and predictive AI solutions, build evaluation pipelines and responsible AI practices, assemble and model enterprise datasets, translate business needs into deployable AI products, and communicate results to stakeholders while driving R&D for GenAI and agentic AI in healthcare.

Perform financial and business analysis including forecasts, variance analysis, and reporting. Maintain spreadsheets and databases, lead ad hoc financial projects, present findings to management, coordinate with departments, and recommend process and outcome improvements.

Support reimbursement strategy for provider partnerships by performing market research, scenario planning, forecasting, profitability analysis, and competitive intelligence. Lead/participate in strategy projects, develop recommendations and presentations for senior leadership, and collaborate with business owners to define problems and implement cost-containment solutions.

Provide sales account support for Stop Loss group accounts: implement and maintain group files, resolve benefit inquiries, coordinate implementations, manage error corrections, support sales cycle tasks, mentor junior colleagues, and manage small-to-medium projects for new business and renewals.

Lead and support enterprise API Gateway platform operations across hybrid environments. Responsible for platform reliability, API security, incident response, infrastructure operations (cloud/Kubernetes), automation, observability, architecture collaboration, operational support, and team leadership including staffing, budgeting, and process improvement.

Administer, support, and enhance Oracle Cloud EPM (primarily Planning/EPBCS) including administration, integrations, business rules (Groovy), metadata, security, Smart View reporting, automated jobs, production support, requirements gathering, testing, documentation, and finance process improvements for planning, forecasting, consolidation, and reconciliation.