- Designs high complexity solutions related to HMSA's provider network to include provider negotiated contracts as well as reimbursement methodology and schedules
- works to build and maintain architecture standards that leverage current and future platforms to include QNXT and CES capabilities and aligns them with an efficient usage of process and custom solutions.
- Establishes quality review standards and is the primary quality review lead.
- Bachelor's degree and four years of related work experience; or equivalent combination of education and work experience.
- Deep understanding of internal control testing procedures and documentation of controls.
- Effective verbal and written communication skills.
- Strong project and process management skills: to handle multiple vendors, multiple contracts, and a wide range of tasks.
- Intermediate level knowledge of Microsoft Office applications. Including but not limited to Word, Excel, Outlook, and Power Point.
- Maintain thorough knowledge of HMSA's provider network and the business with focus on provider contracts and reimbursement methodologies while working collaboratively across departments and our vendor partners to identify, document and maintain business requirements necessary for successful implementation.
- Researches the current state of HMSA's systems to include QNXT & CES configuration, along with related processing, desktop, and system procedures in order to contribute to the requirements development portion of projects & larger BAU assignments. Conducts research & development of new or unused functionality as required, often collaborating with vendors or other partners as appropriate. Communicates & interacts pro-actively across departments within the organization and with vendor partners to:
- Ensure request is complete and the scope & requirements are clearly documented and understood
- Assist in the project planning & scheduling across teams, especially where future versions of HMSA platforms such as QNXT/CES are required
- Recommend changes to requirements in light of research in order to increase and/or improve efficiency, member, or provider satisfaction
- Elicitation and documentation phase of the work request
- Lead configuration research and design team during requirements elicitation
- Recommend changes to configuration and/or Architectural standards based on the use of new functionality
- Works collaboratively across HMSA departments as well as with HMSA's vendor partners to contribute to the design, development, testing & implementation of the most complex configuration & solutions, independently:
- Complies with architecture principles, policies, and standards.
- Identifies, creates, and recommends implementation of changes in architecture principles or standards.
- Actively engages in peer review of all Configuration work through facilitation of discussions as assigned.
- Leads the configuration analysis & design team through the design & development process.
- Identifies solution options and performs & documents cost benefit analysis to determine & recommend the best solution.
- Serves as a primary liaison with internal customers based on project activities or as assigned to gain business knowledge or cross-functional training
- Collect, analyze, and utilize data and feedback to identify opportunities to improve the relationship between the business and provider by increasing operational efficiencies.
- This will include presentations to HMSA leadership and direct communication and participation with the Vendor Management Office (VMO) and Transformation Management Office (TMO)
- Establishes and fosters productive working relationships with internal and external key stakeholders by:
- Effectively conducting meetings and discussions to achieve collaboration, trust, and consensus
- Communicating and assuring delivery on service commitments
- Prioritizing, tracking, and managing deliverables
- Ensuring documentation and reporting are complete and meet compliance requirements
- Proactively solve conflicts and address issues that could occur between HMSA our vendor partners and/or providers
- Routinely conducts configuration audits of vendor to determine if the system updates accurately reflect the functional requirements and technical documents.
- Promptly respond to and compile reports about incidents, events, or updates about an important issue for the business that directly impact Configuration
- Communicates and addresses findings as identified.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
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Liaison, Configuration Provider - Honolulu, United States - realjobshawaii
Description
Job Summary
**Hybrid Work Environment - Must reside in Hawaii **
Pay Range: $64,915 - $103,415
Note: Individuals typically begin between the minimum to middle of the pay range
The Liaison, Configuration Provider -- Provider Operations is responsible for the coordination between HMSA's Provider contracting, configuration, operations, and finance teams and our vendor partners in ensuring that system configuration meets contract and reimbursement requirements. In this role, the Liaison will work collaboratively across HMSA departments as well as externally with our provider partners and the other entities to streamline operations and resolve issues.
The Liaison, Configuration Provider -- Provider Operations serves three primary objectives working across HMSA teams and alongside with our vendor partners:
This role requires the ability to see & analyze the "big picture" while maintaining a level of detail appropriate to the context of HMSA systems to include QNXT & CES configuration as it relates to implementation of provider contracts and reimbursement methodologies.
Minimum Qualifications
Duties and Responsibilities
**For more information and to apply, please visit **
Equal Opportunity Employer - Minorities/Women/Protected Veterans/Disabled
