Directs and provides guidance to employees responsible for timely and accurate responses to providers' inquiries regarding contracting, claims, benefits and complex issues that include medical or payment policy questions and provider payment reviews / appeals. Develops, implements and maintains operational processes to meet Provider Operations goals, provider contract requirements, compliance with industry standards and Government mandates. They ...
Coordinate and monitor activities with appropriate MP and operational departments to ensure that standards are being met timely and accurately. escalate issues as needed. Conduct analysis of ad hoc and questions, research issues, and provide assistance to departments to assess impact and determine best course of action, and document decision / resolution. Responsible for supporting, monitoring, and reporting corrective actions in response to exte...
Responsible for leading and coordinating complex activities in support of HMSA's desktop and end-user infrastructure. Responsibilities include, but are not limited to the following. Responsible for the overall health of HMSA's desktop and end-user infrastructure. Designs, implements, maintains and upgrades HMSA's endpoint and client software. Installs, configures, and troubleshoots computers and related peripherals, software and network connectiv...
As the senior level subject matter expert on Medicare plans, works closely with HMSA management, operational departments, Medicare Compliance Officers, business partners and contracted vendors to provide analysis and consulting services. Responsible to carry out the following key activities independently and with a high degree of professional competence and technical expertise. Provide leadership, training and guidance to other Medicare Programs ...
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, goes back to source if problems are found, and identifies other options / alternatives if problems cannot be resolved. Performs review of data to ensure completeness / accuracy / timeliness for the purpose of the analysis. ...
Conducts audits in the operational areas to include. Monthly audits to monitor controls and performance. Document and review findings with operational staff and management. Track audit results and spot error trends to identify training needs and process improvements. Perform other functions to include. Identify specific case / scenarios beneficial for information sharing and lead discussions of case / scenario in unit meetings. Conducts audit for...
Select, train, and manage designated staff, fostering a work environment that encourages teamwork, promotes personal growth and learning, couples empowerment with accountability, learns from failure and celebrates success. Manage all case management / health coordination activities on their designated island(s) ensuring all assessments, health action plans / care plans are completed and implemented according to Med-QUEST, Medicare, or commercial ...
Select, train, and manage designated staff, fostering a work environment that encourages teamwork, promotes personal growth and learning, couples empowerment with accountability, learns from failure and celebrates success. Manage all case management / health coordination activities on their designated island(s) ensuring all assessments, health action plans / care plans are completed and implemented according to Med-QUEST, Medicare, or commercial ...
