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Provider Field Support Specialist

2 months ago

Honolulu, United States HMSA Full time
  1. Communicates directly with external partners and providers via phone, email or written correspondence in a professional, knowledgeable and timely manner to provide education; to obtain required documentation and/or clarification; and to provide direction in support of onboarding or provider claims inquiries.
  2. Coordinates with internal business for resolution of provider inquiries/issues related to onboarding into HMSA's provider network, claims processing and benefits.
  3. Provides first-level contact for internal business areas to ensure that requests for field outreach are complete, actionable and if not, redirect accordingly. Monitors and analyzes case trends to proactively identify opportunities for improvement and/or development.
  4. Maintain and manage the Field unit's outreach/planning calendar and project list to ensure compliance with all deadlines related to CMS, HEDIS, STARs etc. Actively work with management to develop additional workflows and reporting capabilities for Field outreach/project metrics.
  5. Innovation, process improvement activities
  6. Perform all other miscellaneous responsibilities and duties as assigned or directed.