Provider Call Center Business Specialist
Posted on: January 24, 2023
- Collect, analyze, and utilize data and feedback related to the
Provider Call Center to provide audit oversight upon predefined
contractual criteria and identify opportunities to improve
operations between HMSA and the vendor team. This will include
direct communication and participation with the Vendor Management
Office (VMO) and Transformation Management Office (TMO). Compile
reports about incidents, events, and updates regarding provider
HHIN and phone inquiry issues and provide database management for
- Gathers, reviews, and analyzes information to identify trends,
issues, and potential problems and solutions related to development
and implementation, including but not limited to new products or
services, contract deliverables, enhancements to add functionality
and/or redesigns of systems, both manual and automated, to improve
efficiency, financial models of costing and pricing. This includes
reviewing and validating new implementations.
- Initiates the development of strategies and tactics based on
logical assumptions and facts considering resources, constraints,
and HMSA values. Provides critical assessments of information and
data about current trends and issues and actively and openly shares
with appropriate parties to encourage collaboration for improvement
and change. Translates analysis into solutions and/or options for
consideration of specific HMSA actions, including business process
- Conducts ongoing research and analysis to assess changing needs
of our industry. Provides quality, objective, and professional
analysis. Initiate change and evaluate impact.
- Communicate with vendor team and internal stakeholders to
quickly and accurately obtain or provide information regarding HHIN
inquiry and provider call updates.
- Works directly with cross-departmental team members to complete
tasks and provide status updates. Works with the project team, HMSA
departments and external partners to monitor, collect, communicate,
and distribute information.
- Communicates analysis, assessments, recommendations and
completed work product through professional written and verbal
reports and presentations. Conducts presentations to all levels of
the organization (unit meetings, department meetings, management
meetings, etc.) and our vendor partner to ensure reporting of
quality outcomes are consistent and understood.
- Provides guidance and assistance to the vendor team to ensure
training programs are up-to-date and effective.
- Communicate process changes to vendor to stay current with
government and commercial health plans, agencies and other
- Engages and collaborates with project staff and subject matter
experts with the planning and implementation of project and sub
project work efforts. Supplies or advises in the development of
requirements, reports, budgets, and other analyses, and help solve
operational issues and roadblocks.
- Organize, maintain, and keep readily accessible, all
references, documents, policies, and procedures to ensure accuracy
on the part of the vendor.
- Read, analyze, and interpret business documents such as HMSA's
Medical Policy Manual, plan certificates and Guide to Benefits,
statistical data, product development memos and documents published
by Blue Cross and Blue Shield Association related to program
compliance; the Federal and/or state governments pertinent to the
business (i.e. Federal Register, CMS guidelines, Hawaii Revised
Statutes (H.R.S). Work collaboratively with the Customer Relations
Content Administrator to ensure online resources are up to
- Ensures all appropriate processes are followed and
documentation is completed as required by acting as quality control
checkpoint verifying standards are adhered to.
- Proactively resolve issues that could impact providers and
members and providers.
- Maintain knowledge of current health plan and agency
- Performs all other miscellaneous responsibilities and duties as
assigned or directed.
Keywords: HMSA, Honolulu , Provider Call Center Business Specialist, Other , Honolulu, Hawaii
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