Provider Operations Business Analyst

2 months ago


Honolulu, Hawaii, United States HMSA Full time

Join our team as a Provider Operations Coordinator at our reputable company

  • Developing and managing processes and reports for internal and external performance monitoring of all provider database and credentialing activities to ensure adherence to corporate performance and regulatory guidelines.
  • Understanding and applying healthcare laws, regulations, program guidelines, and contractual obligations that impact Provider Operations' business areas.
  • Collaborating with external and internal teams to implement changes and corrective actions that enhance outcomes and optimize efficiencies identified during performance monitoring.
  • Leading, coordinating, and representing Provider Operations on project teams and interdepartmental initiatives by aligning efforts, crafting requirement documents, and designing test cases related to provider data.
  • Compiling case files for presentation to Provider Operations Leadership and Credentialing Committee to meet HMSA policies, State and Federal regulatory requirements, and accreditation standards for credentialing HMSA providers across commercial, Medicare, Medicaid, and ACA products.
  • Creating and updating Provider Operations program descriptions, policies, and procedures based on current state and federal mandates, accreditation criteria, and internal process enhancements.
  • Handling various responsibilities and tasks as assigned, including database management for escalations.


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