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Honolulu

    Manager, Provider Operations - Honolulu, United States - HMSA

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    Full time
    Description

    Job Summary

    Pay Range: $73,154 - $121,252, position is eligible for an incentive bonus

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

    Responsible for providing leadership direction and oversight of the Provider Call Center. Accountable for supporting and monitoring all aspects of the call center, including implementation and maintenance of training programs and the onboarding process; tracking performance and ensuring that performance guarantees are met and developing corrective action plans if/when necessary; ensuring that all audit and reporting requirements are met; responding to provider escalations; and assisting with the implementation of new technologies. Additionally, represent Provider Operations in critical and/or complex inter departmental strategic goals and initiatives that directly impact the Provider Call Center.

    Minimum Qualifications

  • Bachelor's degree and five years of related work experience; or equivalent combination of education and work experience.
  • Two years of supervisory, management, or leadership experience.
  • Understanding of claims processing and reimbursement.
  • Excellent verbal and written communication skills.
  • Demonstrated project and process management skills.
  • Basic knowledge of Microsoft Office applications including Word, PowerPoint, Excel, and Outlook.
  • Duties and Responsibilities

  • Direct and oversee all aspects of the Provider Call Center, in alignment with corporate goals and initiatives. Manages, oversees, and evaluates staff.
  • Ensure Provider Call Center performance meets/exceeds Key Performance Indicators by evaluating, analyzing, and interpreting data and metrics. Report on or supervise reporting of KPI metrics.
  • Ensure cross-functional collaboration and partnerships are developed and maintained in support of functional alignment.
  • Lead, manage, or direct and coordinate projects that directly impact the Provider Call Center.
  • Collect, analyze, and utilize data and feedback to identify opportunities to improve the relationship between the business and HMSA's provider network.
  • Contribute to the ongoing design, development, and implementation of key core systems utilized by the Provider Call Center.
  • Effectively work with vendor and HMSA staff to resolve claim issues/inquiries accurately at first contact from stakeholders. Maintain ongoing audit program to ensure quality.
  • Respond to provider escalations received via the Provider Call Center as needed.
  • Perform all other miscellaneous responsibilities and duties as assigned or directed.


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