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Provider Operations Business Analyst

2 months ago

Honolulu, United States HMSA Full time


  2. Develop and maintain processes and reports for internal and external performance monitoring of all provider database and credentialing activities to ensure compliance with corporate performance and/or regulatory guidelines.

    • Understanding of healthcare laws and regulations, program guidelines and HMSA contractual obligations that affect Provider Operations' business areas.
    • Effectively work with external and internal teams on implementing changes and/or corrective action plans to improving outcomes and increase efficiencies identified as a result of the performance monitoring.


  3. Lead, coordinate and represent Provider Operations on project teams and interdepartmental efforts by coordinating efforts, creating and/or contributing to requirement documents and developing test cases related to provider data.
  4. Prepare case files for presentation to Provider Operations Leadership and Credentialing Committee in order to satisfactorily meet all standards as required by HMSA policies and procedures, State and Federal regulatory requirements and all relevant accreditation standards pertaining to the credentialing for HMSA providers in all lines of business including commercial, Medicare, Medicaid and ACA products.
  5. Develop and maintain Provider Operations program descriptions, policies and procedures based on current state and federal requirements, accreditation standards, and internal process updates.
  6. Performs all other miscellaneous responsibilities and duties as assigned or directed.


    • To include database management for any escalations