Policy Analyst (Provider Network) #20-6075
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
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
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
Report on findings and observations, and corrective action
Recommend improvements of varying complexities to strengthen
operations in meeting network standards.
Participate on cross functional teams as a member or team
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
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
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
Bachelor's degree and four years of related work experience, or
an equivalent combination of education and related work
Strong analytical skills
Excellent oral and written communication skills.
Demonstrated competence in performing intermediate statistical
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
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application process, please contact 808-948-5588 or via email at