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Liaison, Configuration Provider - Provider Operations HMSA
Maintain thorough knowledge of HMSA's provider network and the business with focus on provider contracts and reimbursement methodologies while working collaboratively across departments and our vendor partners to identify, document and maintain business requirements necessary for successful implementation.
Researches the current state of HMSA's systems to include QNXT & CES configuration, along with related processing, desktop, and system procedures in order to contribute to the requirements development portion of projects & larger BAU assignments. Conducts research & development of new or unused functionality as required, often collaborating with vendors or other partners as appropriate. Communicates & interacts pro-actively across departments within the organization and with vendor partners to:
Ensure request is complete and the scope & requirements are clearly documented and understood
Assist in the project planning & scheduling across teams, especially where future versions of HMSA platforms such as QNXT/CES are required
Recommend changes to requirements in light of research in order to increase and/or improve efficiency, member, or provider satisfaction
Elicitation and documentation phase of the work request
Lead configuration research and design team during requirements elicitation
Recommend changes to configuration and/or Architectural standards based on the use of new functionality
Works collaboratively across HMSA departments as well as with HMSA's vendor partners to contribute to the design, development, testing & implementation of the most complex configuration & solutions, independently:
Complies with architecture principles, policies, and standards.
Identifies, creates, and recommends implementation of changes in architecture principles or standards.
Actively engages in peer review of all Configuration work through facilitation of discussions as assigned.
Leads the configuration analysis & design team through the design & development process.
Identifies solution options and performs & documents cost benefit analysis to determine & recommend the best solution.
Serves as a primary liaison with internal customers based on project activities or as assigned to gain business knowledge or cross-functional training
Collect, analyze, and utilize data and feedback to identify opportunities to improve the relationship between the business and provider by increasing operational efficiencies.
This will include presentations to HMSA leadership and direct communication and participation with the Vendor Management Office (VMO) and Transformation Management Office (TMO)
Establishes and fosters productive working relationships with internal and external key stakeholders by:
Effectively conducting meetings and discussions to achieve collaboration, trust, and consensus
Communicating and assuring delivery on service commitments
Prioritizing, tracking, and managing deliverables
Ensuring documentation and reporting are complete and meet compliance requirements
Proactively solve conflicts and address issues that could occur between HMSA our vendor partners and/or providers
Routinely conducts configuration audits of vendor to determine if the system updates accurately reflect the functional requirements and technical documents.
Promptly respond to and compile reports about incidents, events, or updates about an important issue for the business that directly impact Configuration
Communicates and addresses findings as identified.
Performs all other miscellaneous responsibilities and duties as assigned or directed.
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Honolulu, HI, US, 96814Posted a day ago Customer Service and Sales Representative. HMSA Meet established marketing plan goals, and achieve annual sales revenue and membership growth objectives by effectively promoting and closing prospective sales opportunities.
Perform quick and efficient transaction fulfillment of telephone calls or email from prospective or current HMSA employer groups and members.
Proactively promote HMSA and USAble product options and meet established HMSA and USAble sales goals.
Protect HMSA's market share through the successful renewal and retention of assigned accounts.
Document all prospect inquiries, outcomes, and follow up on sales enrollment opportunities via the telephone or in writing.
Prepare proposals for new small group, new individual plans, Medicare plans, plan upgrades, and additions and modifications to existing plans.
Support phone inquiries for senior plan sales during annual enrollment period.
Meet goals, sales and retention quotas, and minimum activity standards.
Relationships
Serve as the "face of HMSA" to provide HMSA products and servicing to our small business, individual plan, and Medicare plan customers.
Coordinate problem solving associated with group and member inquiries.
Manage internal and external customer relationships to ensure that employer/member product and servicing needs are identified and addressed.
Expand relationships with groups through the sale of new products.
All employees are assigned to health, and product fairs and public service events throughout the year, to represent HMSA at public events.
Administrative
Maintain accurate records of all account activity and provide management with a weekly report on sales opportunities, proposals, jeopardy/lost accounts, sales activities, and servicing issues.
Other Duties/Functions
Performs all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid Kapolei, HI, US, 96709Posted a day ago Port Captain. Young Brothers Responsible for supervising and coordinating all phases of operations relating to the division tugs and barges. Includes direct supervision of Deck Officers and Deckhands. Involved in selection, promotion and training, crewing, governmental and state regulatory and safety compliance standards, budget development & management, casualty investigations, vessel repair, coordination of vessel schedules and operations, and developing and executing operating standards designed to ensure regulatory compliance of personnel and vessels consistent with company policies. Honolulu, HI, US, 96814Posted a day ago Government Policy and Advocacy Coordinator. HMSA Research regulatory and legislative issues and summaries at the state and federal level and analyze the impact these initiatives may have on HMSA. Draft legislative testimony and advocacy papers.
Manage HMSA's Political Action Committee (PAC). Manage and staff HMSA's PAC.
Comply with all federal and state regulatory agency requirements and submit requisite reports for PAC and lobbyists.
Develop and manage internal fundraising efforts and educational events.
Manage the daily operations of the Hawaii Association of Health Plans.
Assist SVP in role as President of the Association.
Draft legislative testimony and advocacy papers for the Association.
Update HAHP website as needed.
Compose internal communications on legislative and healthcare issues.
Respond to internal inquiries from simple to complex regarding legislative and healthcare issues.
Coordinate and participate with other internal departments in cost impact analysis and policy identification for legislative issues.
Assist in the preparation and follow-up of external and internal department-related meetings. Assist in the development of presentations and collateral materials for both external and internal audiences.
Schedule legislative meetings and coordinate functions for legislative events. Respond to legislative inquiries.
Provide administrative support that includes, but is not limited to:
Assists with special events and projects including employee recognition events, meetings, community events, and other duties to support department operations as assigned.
Helps to orient new employees to the department. Serves as a key resource in helping new employees navigate the processes at HMSA.
Support office operations that include, but is not limited to:
Efficiently prepare, distribute, and scan mail and other documents as needed. Arrange couriers as needed and ship items to other locations.
Take lead on office supplies and equipment: Inventory supplies and prepare purchase orders as needed.
Work with facilities department to arrange for work requests for space or facilities needs for department.
Take lead on all activities involving offsite document storage/boxes by ensuring they are properly indexed and organized. Ensure all requests for boxes are handled in a timely manner. Oversee documents under legal hold and arranged to have expired documents destroyed.
Assists with scheduling meetings, reserving meeting rooms, taking notes, and completing access requests.
Act as department travel coordinator:
Arrange all aspects of travel for department including, but not limited to, airfare, transportation, lodging, and prepared and processing of travel authorization forms. Assist with all aspects of conference registrations.
Act as Emergency Response Coordinator:
Responsible for leading department's evacuation from HMSA Center to evacuation area; identifying employees needing Special Accommodations; Maintaining department's Emergency Evacuation Employee (EEE) list; and notifying building management and Business Continuity of departmental changes.
Performs all other miscellaneous responsibilities and duties as assigned or directed. Honolulu, HI, US, 96814Posted a day ago Licensed Asst. Engineer (Kapena) Young Brothers As a Minimum must possess a US Coast Guard engineer's license DESIGNATED DUTY ENGINEER with no horsepower limitations, 3rd ASSISTANT ENGINEER UNLIMITED, or CHIEF ENGINEER LIMITED. You must also possess a STCW Certificate Endorsed for regulation III/1. Must complete the company's Personnel Qualification Standard (PQS) for Engineer within 90 days of effective hire or promotion date. Must possess a current driver's license. High School or GED is required. Must possess, at least, two (2) years of marine diesel engine experience or equivalent (i.e. Training at a Maritime Academy). submit your engine room sea time letters with your credentials. Honolulu, HI, US, 96814Posted a day ago Lead Investigator. HMSA Perform Investigator staff oversight, and coaching on day-to-day investigation activities including, but not limited to FWA case reviews and approvals, regulatory referrals, documentation, reporting, overpayment processing and prevention. Honolulu, HI, US, 96814Posted a day ago Manager, Health Finance & Analytics. HMSA Partners with analytics teams to facilitate idea generation and quantification of savings initiatives (areas of focus includes but is not limited to provider contracting, utilization management, care management, risk adjustment, operational efficiencies, population health, product design, etc.). Will also ensure quality and accuracy of cost analytics and insights related to claim cost drivers for business segments. Honolulu, HI, US, 96814Posted a day ago Network Management Specialist -- Medical Record Retrieval. HMSA Monitor, evaluate, interpret, and disseminate program requirements related to risk. Ensure activities are conducted in accordance with applicable standards, line of business controls and requirements. Develop methods to improve daily operations and practice standards. Honolulu, HI, US, 96814Posted a day ago Solutions Delivery Manager. HMSA For applications/systems assigned, leads and/or coordinates business and technical planning with clients, business analysts, architects, and team members. Directs the problem resolution activities including communication throughout the organization for all severity 1 and 2 application/system problems. Communicates with the business owner, IS management, and customers on a regular basis as to the status of the application or systems and any work requests. Honolulu, HI, US, 96814Posted a day ago PHARMACIST. BrightSpring Health Services * The resident will design and conduct an original research project to be presented in a poster format at the annual conference of the College of Psychiatric and Neurologic Pharmacists (CPNP) to be held in April Kaneohe, HI, US, 96477Posted a day ago Liaison, Configuration Provider - Provider Operations HMSA |
Honolulu, HI, US, 96814 Apply Now Description
Maintain thorough knowledge of HMSA's provider network and the business with focus on provider contracts and reimbursement methodologies while working collaboratively across departments and our vendor partners to identify, document and maintain business requirements necessary for successful implementation.
Researches the current state of HMSA's systems to include QNXT & CES configuration, along with related processing, desktop, and system procedures in order to contribute to the requirements development portion of projects & larger BAU assignments. Conducts research & development of new or unused functionality as required, often collaborating with vendors or other partners as appropriate. Communicates & interacts pro-actively across departments within the organization and with vendor partners to:
Ensure request is complete and the scope & requirements are clearly documented and understood
Assist in the project planning & scheduling across teams, especially where future versions of HMSA platforms such as QNXT/CES are required
Recommend changes to requirements in light of research in order to increase and/or improve efficiency, member, or provider satisfaction
Elicitation and documentation phase of the work request
Lead configuration research and design team during requirements elicitation
Recommend changes to configuration and/or Architectural standards based on the use of new functionality
Works collaboratively across HMSA departments as well as with HMSA's vendor partners to contribute to the design, development, testing & implementation of the most complex configuration & solutions, independently:
Complies with architecture principles, policies, and standards.
Identifies, creates, and recommends implementation of changes in architecture principles or standards.
Actively engages in peer review of all Configuration work through facilitation of discussions as assigned.
Leads the configuration analysis & design team through the design & development process.
Identifies solution options and performs & documents cost benefit analysis to determine & recommend the best solution.
Serves as a primary liaison with internal customers based on project activities or as assigned to gain business knowledge or cross-functional training
Collect, analyze, and utilize data and feedback to identify opportunities to improve the relationship between the business and provider by increasing operational efficiencies.
This will include presentations to HMSA leadership and direct communication and participation with the Vendor Management Office (VMO) and Transformation Management Office (TMO)
Establishes and fosters productive working relationships with internal and external key stakeholders by:
Effectively conducting meetings and discussions to achieve collaboration, trust, and consensus
Communicating and assuring delivery on service commitments
Prioritizing, tracking, and managing deliverables
Ensuring documentation and reporting are complete and meet compliance requirements
Proactively solve conflicts and address issues that could occur between HMSA our vendor partners and/or providers
Routinely conducts configuration audits of vendor to determine if the system updates accurately reflect the functional requirements and technical documents.
Promptly respond to and compile reports about incidents, events, or updates about an important issue for the business that directly impact Configuration
Communicates and addresses findings as identified.
Performs all other miscellaneous responsibilities and duties as assigned or directed.
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