Healthcare Services Analyst III

1 week ago

Honolulu, United States Hawaii Medical Service Association Full time $53,000 - $99,000

Pay Range: $53,000 - $99,000

Note: Individuals typically begin between the minimum to middle of the pay range

Responsible for the research, analysis, development, implementation and coordination of new/revised reimbursement policies, benefits, and contracts. This analyst initiates and performs all activities related to the appropriate administration of these activities, which are based on an excellent working knowledge of HMSA's business as well as medical, benefit, contracting, and reimbursement policies/edits. Is able to analyze and present large amounts of data clearly.

Assists in training and support to analysts in the unit and in other units/departments. May coordinate projects across departments to improve workflows, benefit/policy implementations and compliance.

Works with multiple departments to implement complex guidelines, laws or policies from various sources including CMS, CDC, and other carriers.

Provide training and support to analysts in the unit and in other units/departments. Coordinates projects across departments to improve workflows, benefit/policy implementations and compliance.


Minimum Qualifications
  • Bachelor's degree or equivalent combination of education and work experience.
  • Three years of related work experience.
  • Effective verbal, written communication skills
  • Excellent organizational and analytical skills
  • Must possess working knowledge of medical terminology, anatomy, and health plan benefits.
  • Good working knowledge of Microsoft Office Application

Duties and Responsibilities
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Continuing Education:
    • Attends and successfully completes HMSA and Continuing Education training classes as assigned.
  • Other duties as assigned

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