Job Description: Data Management: Reviews data sources and preps needed data. Identifies existing and new data sources. Performs data prototyping, if necessary, to agree what data can/not be used. Preps data for use in analysis, go...
Job Description: Oversees development and implementation of HMSA's provider contracting strategy and the primary team responsible for execution of provider contracts. Leadership Provide direction and guidance to staff on provider...
Job Description: Data Management: Reviews data sources and preps needed data. Identifies existing and new data sources. Performs data prototyping, if necessary, to agree what data can/not be used. Preps data for use in analysis, go...
Job Description: Fee Reviews Lead the Fee Review Process which includes analyzing and explaining complex policy and reimbursement issues to providers, Professional Reimbursement and HMSA leadership Prepare cases for Operations Manag...
knowledge of medical terminology, health industry coding systems (procedure and diagnosis codes, etc.), CMS1500 or UB04 claim...
Job Description: Utilize medical necessity criteria from established medical policies and clinical practice... guidelines to render precertification determinations as described in the Medical Management UM work plan. This detailed clinical...
and community organizations. Act as a liaison and mediator between participants, families, and service providers addressing... Hawaii license of LCSW, LSW, RN, LMHC, or other licensed clinician. Effective verbal and written communication skills...
knowledge of medical terminology, health industry coding systems (procedure and diagnosis codes, etc.), CMS1500 or UB04 claim...
a multi-disciplinary team to develop a person- centered care plan to include but not limited to member's PCP, other service... others in order to ensure timely access to appropriate medical care, behavioral health care, and services. Document and resolve...
as appropriate. Monitors Key Performance Indicators and maintains service levels to ensure that requirements are met or exceeded... Service Management tools to document changes and identify recurring problems. Identifies the training needs of users. Shares...