Healthcare Services Analyst I
HMSA•Honolulu, HI
About The Position
This role involves researching and analyzing healthcare services, policies, and claims. The analyst will learn to assess the business impact of new benefits and policy changes, conduct cost-benefit analyses, and drive the implementation of changes. Responsibilities include updating and creating pend resolutions, loading new codes, and identifying workflow improvements. The position also requires continuing education and other assigned duties.
Requirements
- Bachelor's degree or equivalent combination of education and work experience.
- One year related work experience.
- Effective verbal, written communication skills.
- Excellent organizational and analytical skills.
- Good working knowledge of Microsoft Office applications.
Responsibilities
- Research and respond to low complexity internal and external inquiries using various resources.
- Assess business impact of new benefits, changes in medical or reimbursement policies/guidelines, and tactics.
- Conduct cost/benefit analysis of claims processing using SQL, MicroStrategy, and other tools.
- Develop documentation for cost/benefit and business impact analysis, and recommendations for claims processing.
- Update and create CES pend resolutions.
- Drive implementation of changes through Work Intake Forms, multi-department meetings, requirements contribution/review, test case validation, and post-implementation monitoring.
- Focus on low complexity project implementations and pend resolution updates.
- Learn to load new codes (CPT, HCPC, ICD-10, etc.) with guidance.
- Prepare and submit files for review and configuration implementation.
- Review new codes and work with Medical Management and Configuration for appropriate claims processing/editing.
- Support audits of implemented policies and completed projects.
- Identify and investigate areas involving cost increases, uncontrolled payments, and/or inequitable payments.
- Identify and resolve issues and trends resulting from implementation requests, problem reports, and inquiries.
- Develop clear, concise documentation for complex business scenarios to inform policy/project systems and workflow requirements.
- Attend and complete assigned HMSA and Continuing Education training classes.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
