<ol>
<li>Serve as Provider Operations subject matter expert on major department and corporate initiatives, projects, process improvement or any other major activity as assigned by management independently.</li>
<li>Independently be able to ensure Provider Operations' needs are addressed; must be able to clearly articulate business needs so that the department is not negatively affected and elevate concerns and issues to management when applicable. Pursue issues until a satisfactory resolution is reached.</li>
<li>Independently conduct data analysis related to major projects and operational activities that includes the following activities: 
<ul>
<li>Design analysis and the gathering and analyzing of data</li>
<li>Analyze trending information in order to identify root causes and develop recommendations for resolution, prevention procedures and processes</li>
<li>Constructing documentation analysis and execute solutions as directed by management.</li>
</ul>
</li>
<li> Work directly with providers both through writing and over the phone to resolve complex inquiries.</li>
<li>The Business Analyst I must be able to proactively identify, research, and conduct analyses to resolve issues and trends that might negatively impact the department and HMSA as a whole.</li>
<li>Performs all other miscellaneous responsibilities and duties as assigned or directed</li>
</ol>

#LI-Hybrid

<ol>
<li>Standard Notification 
<ul>
<li>Manage activities related to communication and notification efforts.</li>
<li>Coordinate and facilitate deliverables and timelines to ensure notifications are sent within required timelines.</li>
</ul>
</li>
<li>Project Implementation 
<ul>
<li>Serve as the subject matter expert for Pharmacy Management with regards to communications or notifications.</li>
<li>Collaborate with internal and external areas to ensure project notification needs are met.</li>
<li>Understand the communication needs and intent to ensure appropriate message is relayed to internal & external entities</li>
<li>Assist with the development of documents and materials for internal and external distribution including but not limited to training materials, impact analyses</li>
<li>Prepare communications project status reports for management, other departments, partners or others as required</li>
<li>Ensure compliance with internal policies, procedures and workflows and new or revised business requirements</li>
<li>Coordinate and facilitate deliverables and timelines to ensure notifications are sent within required timelines.</li>
</ul>
</li>
<li>Information Validation 
<ul>
<li>Validation of impact analyses related to Pharmacy Management notifications.</li>
<li>Validation of Pharmacy Management postings to HMSA.com & PRC. 
<ul>
<li>Review of links to ensure information posted is accurate and up-to-date including but not limited to formulary documents, payment polices.</li>
</ul>
</li>
</ul>
</li>
<li>Benefit Support 
<ul>
<li>Manage inquiries coming to Pharmacy Management 
<ul>
<li>Triage inquiries to ensure servicing needs identified and addressed.</li>
<li>Coordinate problem solving associated with inquiries.</li>
<li>Maintain accurate records of how inquiry was addressed in efforts to identify gaps or opportunities for improvement for Pharmacy Management or for HMSA</li>
</ul>
</li>
<li>Monitor and evaluate accuracy of benefit delivery system through report development and review. 
<ul>
<li>Defines and maintains system functionality for drug claims processor, including, but not limited to the drug claims processing, such as UM edits, formulary updates and benefit design & delivery</li>
</ul>
</li>
</ul>
</li>
<li>Document and update workflows and procedure documents. As well as analyze business problems, current workflows and processes to improve efficiency.</li>
<li>Performs all other miscellaneous responsibilities and duties as assigned or directed.</li>
</ol>
 
#LI-Hybrid

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.
Responsible for leading the development, implementation, and maintenance of specialty drug programs, projects, and tactical initiatives including regulatory compliance, ensuring fiscal successes, and coordinating efforts with HMSA's strategic partners and internal stakeholders.
Minimum Qualifications
Bachelor's degree and two years of work-related experience or equivalent combination of education and experience.
Effective written and verbal communication skills.
Proficiency in problem solving and data collection, analysis, and interpretation.
Knowledge/skills in project management and coordination.
Strong organization and time management skills to work on multiple projects simultaneously and meet project deadlines.
Strong interpersonal skills.
Proficiency in development and execution of operational process flows.
Knowledge of relevant statistical analyses.
Working knowledge of database and spreadsheet programs.
Intermediate working knowledge of Microsoft Office applications, including but not limited to Word, Excel, PowerPoint, and Outlook.
Duties and Responsibilities
Project Team Leadership:
Lead cross-functional project staff, subject matter experts, and vendor partners with the initiation, strategy setting, planning, and implementation of various business-critical projects.
Develop and analyze requirements, reports, policies, procedures, and other formal documentation to meet regulatory compliance operations and oversight.
Create and maintain project schedule, track critical milestones, and project dependencies.
Advance project work to ensure timely completion of deliverables.
Cross-functional integration and interaction:
Represent the department on corporate initiatives and projects. Partner with other department units to ensure project expectations are understood, business requirements are identified, and appropriate priority and resources are assigned to fulfill project requirements.
Work with vendors and cross-functional staff and business owners to monitor, collect, communicate, and distribute information related to the Specialty Drug solution.
Communicate analysis, assessments, recommendations, and completed work product through formal channels.
Research and analysis:
Gather and review information to identify trends and issues.
Develop strategies and tactics based on resources, constraints, and HMSA values.
Provide objective analysis of data and/or industry standards with recommendations to management.
Ongoing assessment of program measures to ensure alignment with corporate goals and objectives.
Managerial support:
Lead vendor management and evaluation.
Other duties:
Perform all other miscellaneous responsibilities and duties as assigned or directed.

#J-18808-Ljbffr

Job Summary

Hybrid Work Environment - Must reside in Hawaii.

Function as a business analyst for programs, projects, and other related tactical initiatives by helping to guide project teams and operational units in their planning, research, analysis, project management, and communication efforts necessary to develop, modify, and implement successful programs.

Minimum Qualifications

Bachelor's degree and three years of related work experience; or equivalent combination of education and experience.
Knowledge of basic relevant statistical analyses.
Proficiency in problem solving and data collection, analysis, and interpretation.
Strong oral and written communication skills.
Basic working knowledge of Microsoft PowerPoint.
Intermediate working knowledge of Microsoft Word, Excel, and Outlook.
Duties And Responsibilities

Project Team and Operational Units Participation: Assist project staff and subject matter experts with the planning and implementation of work efforts. Help with the development of requirements, reports, and other analyses to help solve operational issues and roadblocks.

Research and Analysis: Gather and review information to identify trends, issues, and potential problems.
Develop strategies and tactics based on logical assumptions and facts considering resources, constraints, and HMSA values.
Provide quality, objective, and professional analysis.

Cross-Functional Integration and Communication: Work with the project team, HMSA departments, and external partners to monitor, collect, communicate, and distribute information.
Communicate analysis, assessments, recommendations, and completed work product through professional written and oral reports and presentations.

General: Special Projects and perform other support duties and accept responsibility as assigned.
May also provide assistance to executives in other departments.

Other Duties/Functions: Cooperate with other staff members both within and outside the department in the accomplishment of one's own job duties as well as assisting others in accomplishing theirs.
Serve as a team player and role model for other employees in the organization by exhibiting traits of courtesy, caring, helpfulness, and respect.
Conduct oneself in a service-oriented manner that is attentive, pleasant, cooperative, sensitive, respectful, and kind when dealing with members, visitors, the public, and all employees.

Perform all other miscellaneous responsibilities and duties as assigned or directed.

#J-18808-Ljbffr

Analyzes business problems, including enhancements to add functionality and/or redesigns of systems or processes to improve efficiency. Defines system functionality for systems analysts and programmers, including the definitions of screens, reports, and internal processing, such as edits, calculations, etc. Develops business requirements, performs testing, and interfaces with programmers or vendors. Prepares recommendations for consideration by management based on analysis of project activities.

Coordinates implementation with internal and external users, including the development of process documentation. Develops, implements, and monitors to completion activities that result from assigned project(s) and/or independent analysis. Coordinates implementation within the department, including the development of processing and procedure documentation, training materials, and employee training.

Develops, implements, and monitors to completion activities that result from assigned project(s) and/or independent analysis. These can include but are not limited to:

changes in the definition of workflows and procedures

development of reports that result in decreases in claims inventory and aging

identification of claims processing issues that can be addressed by development of problem reports, ISSs, coding, or system and/or configuration enhancements.

supports the definition of system and/or configuration requirements and systems testing for ongoing automation of operational activities and processes.

Defines acceptance testing criteria and ensures that the criteria are met before system changes or configuration changes are implemented. May assist in unit/system testing.

Performs all other miscellaneous responsibilities and duties as assigned or directed.

#J-18808-Ljbffr

Job Summary
Hybrid Work Environment - Must reside in Hawaii **

Responsible to support the development and implementation of required activities to ensure compliance with Centers for Medicare and Medicaid Services (CMS) requirements and mandates, that ensures compliance with Medicare contracting and reporting requirements.

Coordinate operational activities with appropriate department personnel, establish work plans, target dates, conduct regular status meetings, report status, identify and escalate issues, recommend solutions, track, and report to resolution. Develop and prepare HMSA's corrective action plans in response to audit or monitoring findings to meet performance standards. Serve as the department's representative/liaison on organizational projects/workgroups.

Minimum Qualifications
Bachelor's degree and three years of related work experience; or equivalent combination of education and related work experience.
Effective oral and written communication skills.
Strong analytical and interpretive skills.
Effective analytical and interpretive skills.
Intermediate working knowledge of Microsoft Office Word and Excel.
Basic working knowledge of Microsoft Outlook and PowerPoint.

Duties And Responsibilities Support the administration and management of the day to day operational activities needed to comply with CMS requirements and HMSA standards. Be knowledgeable on all CMS regulations and HMSA operational standards. This duty requires the analyst to:
Ensure all HMSA's Medicare Program contractual obligations and requirements are met or exceeded in appropriate operational depts. 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. Then monitor compliance via report and data validation.
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.
Handle ad hoc questions, research issues, and provide assistance to departments to assess impact and determine best course of action.
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.
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. Monitor and track HMSA's compliance with CMS program standards, policies, and guidance through multiple sources, such as HMSA submitted reports to CMS, CMS generated performance metrics, and department self-reported issues.
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.
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.
Performs all other miscellaneous responsibilities and duties as assigned or directed.

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