Senior Operations Analyst

7 days ago


Honolulu, Hawaii, United States HMSA Full time
About the Role

We are seeking a highly skilled Senior Operations Analyst to join our team at HMSA. In this role, you will be responsible for supporting the administration and management of day-to-day operational activities needed to comply with CMS requirements and HMSA standards.

Key Responsibilities
  1. CMS Compliance and Guidance
  • Ensure all HMSA's Medicare Program contractual obligations and requirements are met or exceeded in appropriate operational departments.
  • Interpret CMS regulations and provide operational impact guidance to departments and HMSA's contracted vendors.
  • Adjust existing systems, operations, and/or workflows to adapt to the ever-changing requirements of CMS and any identified deficiencies in current program quality and administration.
  • Monitor compliance via report and data validation.
Communication and Follow-up
  • Monitor communications from CMS and determine if/how changes to operations are needed in applicable internal departments.
  • Follow-up to ensure correct action was taken on a timely basis.
Administrative Support
  • Handle ad hoc questions, research issues, and provide assistance to departments to assess impact and determine best course of action.
Reporting and Compliance
  • Complete administrative reports based on business needs, program compliance, plan performance, and as assigned.
  • Advise the manager on significant matters pertaining to regulatory and reporting requirements, program compliance, or needed program changes.
Member Cases and Quality Assurance
  • Resolve all member cases and ensure CMS timeliness and accuracy requirements are met.
  • Conduct quality assurance and process improvement reviews to assess compliance and verify appropriate actions are taken.
Policies and Procedures
  • Coordinate, develop, and help implement Medicare Program policies and procedures to operationalize CMS requirements affecting multiple departments.
  • Maintain understanding of Medicare program operations as it relates to marketing, membership enrollment, claims processing, financial statements, customer service, provider contracting, quality improvement, utilization management, etc.
Coordination and Monitoring
  • Obtain policy clarifications/additional guidance, coordinate special administrative and operational requests, respond to CMS inquiries and requests for information, and coordinate CMS performance reviews.
  • Participate in the development and implementation of required corrective action plans to address CMS audit and internal quality assurance review findings.
  • Coordinate and monitor activities with appropriate department staff to ensure that corrective action plans are implemented timely and accurately.
Other Responsibilities
  • Perform all other miscellaneous responsibilities and duties as assigned or directed.

Estimated Salary: $65,000 - $90,000 per year



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