Apply on Employer Site

HMSA · 4 hours ago

Manager, Provider Research

Honolulu, HI

Full-time

Hybrid

Mid, Senior Level

$68K/yr - $133K/yr

5+ years exp

HMSA is seeking a Manager for Provider Research to oversee and manage staff responsible for provider research and support activities. The role involves direct communication with providers, data analysis, and leading technological initiatives to enhance provider relations.

AssociationHealth CareInsuranceMedical

Responsibilities

Manage staff, ensuring provider inquiries are responded to timely, accurately, and professionally. Resolve complex provider inquiries

Respond to and oversee staff responding to CMS demand letters

Participate in ad hoc projects to help enhance the provider experience with HMSA. These may include but are not limited to enhancements of provider online resources and development of content for the HealthPro news and Provider Resource Center

Analyze relevant data sources to proactively help identify and resolve issues affecting providers

Oversee training activities and the creation of training materials, workflows, and desktop procedures. Prepare and conduct presentations for staff and management

Develop staff in a manner that ensures continual growth and opportunities while maximizing efficiency for providers and the department

Integrate Claims Adjustment Specialists into the Research and Correspondence unit by implementing a plan for the pend resolutions to be worked and ensuring audit compliance

Lead the Research and Correspondence team in technological initiatives including existing application upgrades, adopting new applications, and ongoing refinement of the team's use of the SalesForce application

Coordinate reporting requirements for the unit including but not limited to inventory management reports and ad hoc claim queries

Performs all other miscellaneous responsibilities and duties as assigned or directed