Analyst

2 weeks ago

Honolulu, United States HMSA Full time


  2. Benefit and policy analysis & implementation:


    • Assess business impact of new benefits, changes in medical or reimbursement policies/guidelines and tactics assigned in strategic planning.
    • Initiate, develop, coordinate and implement cost/benefit analysis of claims processing.
    • Extract and analyze data using SQL, MicroStrategy and/or other tools as available.
    • Develop documentation, including cost/benefit and business impact analysis and recommendations to implement and/or improve claims processing.
    • Update and create CES pend resolutions.
    • Drive implementation of changes through writing of Work Intake Form, participation in multi-department meetings, contribution and review of requirements, validation of test cases, and post-implementation monitoring.
    • Focus on medium to high complexity project implementations.
    • Lead on enterprise or multi-year projects.


  3. Research and Analysis:


    • Research and respond to medium to high complexity internal and external inquires.
    • Utilize a variety of resources including but not limited to on-line information files and databases, Medicare/other plan guidelines, plan certificates, provider contracts.
    • Make recommendations and decisions independently.


  4. Software implementation:


    • Participate in the unit‘s efforts to implement new projects, software or software modifications.
    • Participate in the development of user requirements, test scenarios, and test validation activities.


  5. Post-implementation trends and workflow improvements:


    • Lead audits of implemented policies and completed projects. Identify and investigate areas involving cost increases, uncontrolled payments and/or inequitable payments.
    • Identification and resolution of issues and trends as a result of researching and responding to implementation requests, problem reports, and inquiries.
    • Develop clear, concise documentation complex business scenarios. This documentation will be used to develop policy/project systems and workflow requirements.


  6. New Code Implementation:


    • Review new codes in assigned categories, work with Medical Management and Configuration to ensure appropriate claims processing/editing based on new code review.


  7. Project Coordination:


    • Assists Coordinator or leads project coordination, with minimal/appropriate oversight, the initiation, planning, and implementation phases of unit, department, cross department, or enterprise wide projects and activities as well as post-implementation activities through the following:
    • Leads/assists in the project planning process with other business owners, stakeholders, and representatives from other units/departments
    • Creates workflows and progress schedule to ensure alignment with project/activity goals.
    • Understands the current ‘AS-IS‘ process, identifies or defines the business need and scope
    • Gathers the business requirements, impact and final recommendations for implementation
    • Tracks progress and provides status to other stakeholders
    • Post-implementation coordination of audits, monitoring and post-payment review as needed based on size impact.


  8. Management Assistance:


    • Contributes to team effectiveness by analyzing operating functions in order to create and revise systems and procedures used to implement new and improve existing operational efficiencies.
    • Represents the unit and department in various corporate activities.


  9. Training (Enterprise & Unit):


    • Assists in creating/reviewing training material, conducts formal training sessions with staff, and communicates results of analysis to individual groups of internal and external customers. May include enterprise-wide training or presentations. Methods of communication can include but are not limited to scheduled meetings, conference calls, memos, training documents, claims filing instructions, pend resolution instructions.
    • Creates and maintains training material and conducts formal training sessions with BIM staff through one-on-one and group sessions to communicate new or revised business requirements that affect workflows.


  10. Continuing Education:


    • Attends and successfully completes HMSA and Continuing Education training classes as assigned.


  11. Other duties as assigned


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