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Exempt or Non-ExemptExempt
Coordinates the resolution of providers' issues, including reimbursement, claims processing, medical and payment policies. Communicates issue resolution directly with providers. Participates on cross department workgroups representing the provider and Provider Services Department. Identifies and implements business change improving provider experiences with HMSA.
- Bachelor's degree and 2 years related work experience; or an equivalent amount of education and related work experience.
- Excellent verbal and written communication skills.
- Basic Microsoft Office skills ((e.g. Word and Email (Outlook, etc.)).
Duties and Responsibilities
- Coordinates case resolution with internal business areas to respond timely and accurately to provider inquiries regarding claims, benefits and medium complex issues that include medical or payment policy questions and provider appeals. Resolve root problems to ensure compliance with contract terms and servicing goals. Communicates directly with providers and office staff to develop case information and communicate issue resolution. Issues researched and resolved are of medium complexity.
- Participates on cross department workgroups representing Provider Services Department. Identifies impacts to providers and communicates the provider's perspective to internal business areas. Coordinates system issue resolution and is responsible to facilitate internal and external communications about core system changes and issues. Develops business requirements and test cases to validate system changes and upgrades meet business requirements.
- Develops education and training material for providers and their staff including workshop presentations and written educational material. Coordinates content development with other business areas and gains business approval. Coordinates and develops provider communications to ensure information is available to providers timely and accurately.
- Coordinates and maintains Provider Servicing staff training program. Train new employees and supplements training with ongoing guidance and mentoring to research and field staff. Develop and maintain success measurement activities that support department goals.
- Develops, implements and maintains Department workflows and procedures. Identifies and participates in process improvements for greater operational efficiency.
- Perform other duties/functions as assigned.