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Policy Analyst (Provider Network)

Company: Hawaii Medical Service Association
Location: Honolulu
Posted on: September 13, 2020

Job Description:

Policy Analyst (Provider Network) #20-6075

Island

Locations

Kapiolani-OLHMS

Company

Employment Type

Full-time

Job Summary

The Network Policy Analyst is responsible for the successful planning, design and management of provider network to comply with compliance standards and adequacy requirements that range in scope from short term, medium level importance to full coordination of Corporate Tactical Initiatives and Regulatory/Compliance Requirements as directed by the Department Manager.

Duties and Responsibilities

Network Design, Management and Execution

Assess and establish network plan to monitor compliance with federal and state regulations, government program rules and sub-regulatory guidance and internal policies and standards. This includes but is not limited to:

Identify available networks in applicable lines of business (commercial, Medicaid, and Medicare) and programs, and conduct network analysis to establish access and compliance requirements.

Assess needs and develop project plan(s) including phases, work plans, deliverables and expected outcomes.

Design network reporting templates or other tools as needed, and ensure that program documentation and reporting are complete and meet compliance requirements. Prepare project reports for management, partners, or others as required.

In collaboration with relevant business areas, gather business requirements to determine network program timeframes, staffing requirements, funding limitations, in addition to ongoing reassessment, reprioritization and/or modifications.

Manage deliverables and timeline. Direct and/or guide program and network related development activities performed by others. Review status reports prepared by project personnel to ensure project progresses on schedule within prescribed budget guidelines.

Resolve department project issues or issues assigned by team lead. Identify organizational strengths and weaknesses and suggests areas of improvement. Develop functional specifications and system design specifications for program development opportunities. Review and edit requirements, specifications, business processes and recommendations related to proposed solution.

Identify root causes of non-compliance, deficiency, or other irregularity.

Report on findings and observations, and corrective action plans.

Recommend improvements of varying complexities to strengthen operations in meeting network standards.

Participate on cross functional teams as a member or team lead.

Network Monitoring and Oversight Lead the establishment of a system for maintaining necessary documentation related to network access and compliance monitoring activities. Provide oversight and provide department leadership on regular status reports on network monitoring activities. Conduct process measurement review and analysis, program evaluation(s) and/or statistical analysis as needed. Directs others to conduct data analysis or abstraction as needed.

Requirements Deliverables In collaboration with relevant HMSA internal teams, monitor and analyze new laws, rules, regulations and guidelines as well as changes to existing rules & regulations related to network management. Convert statutory language to network requirements for business areas. Provide timely response to RFPs and ensure compliance with new laws, rules, regulations and guidelines for HMSA's provider network.

Network Performance Evaluation Promote ongoing overall network access and compliance to ensure appropriate network performance. Function as one of the liaisons between Provider Services and representatives of Internal HMSA Departments and be responsible for the development and tracking of all written and verbal communication related to network development, access oversight, and network regulatory compliance. Communicate objectives to obtain buy-in from department leadership to align network performance to audit standards.

Other Duties/Functions Assist manager in managing work; resources, budget, and other managerial duties as assigned.

Other duties as assigned.

Exempt or Non-Exempt Exempt

Minimum Qualifications

Bachelor's degree and four years of related work experience, or an equivalent combination of education and related work experience.

Strong analytical skills

Excellent oral and written communication skills.

Demonstrated competence in performing intermediate statistical analysis.

Demonstrated presentation skills.

Excellent multitasking and time management skills.

Ability to work independently and collaboratively.

Demonstrated ability to establish and maintain effective working relationships with people at all levels.

Intermediate level of knowledge of Microsoft Office suite products (e.g. Word, Excel, etc.)

Equal Opportunity Employer - Minorities/Women/Protected Veterans/Disabled We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact 808-948-5588 or via email at jobs@hmsa.com.

Keywords: Hawaii Medical Service Association, Honolulu , Policy Analyst (Provider Network), Other , Honolulu, Hawaii

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