HRSN Community Partnerships Specialist

Hawaii Medical Service Association•Honolulu, HI

About The Position

The HRSN Community Partnerships Specialist serves as the day-to-day contact for HRSN providers and community-based organizations participating in, or preparing to participate in, HRSN service delivery. The role supports provider onboarding into HMSA’s network by coordinating with internal teams on contracting, credentialing, provider enrollment, administrative setup, and operational readiness. It also develops, coordinates, and delivers provider education on program requirements, workflows, documentation, referrals, authorizations, billing, claims, invoices, and reporting. The specialist maintains provider capacity information, coordinates member assignments when referrals do not specify an available provider, and researches and coordinates resolution of provider, member, and referral issues. The role works across HRSN Program leadership and internal operational teams, as well as community partners, to address access barriers, resolve operational issues, and support implementation and improvement of HRSN services. The position also supports community stakeholder engagement, provider convenings, workgroups, trainings, feedback loops, and program implementation. It assists with provider monitoring and documentation, including annual on-site visits for medical respite providers when applicable, and maintains records to support MQD expectations, audit readiness, and program integrity. The specialist escalates trends, risks, and unresolved barriers and supports corrective action tracking as needed. Other responsibilities may be assigned or directed.

Requirements

Bachelor’s degree and four years of related experience in healthcare, Medicaid managed care, provider relations, community engagement, program operations, care coordination, social services, or a related field.
Experience coordinating with providers, community-based organizations, members, or internal business partners to resolve operational issues and support program implementation.
Strong relationship-building, communication, facilitation, and issue-resolution skills; ability to work effectively with providers, community organizations, members, internal teams, and government partners.
Ability to clearly communicate program requirements, workflows, and operational expectations to external stakeholders with varying levels of Medicaid experience.
Working knowledge of regulated healthcare program requirements, provider operations, documentation standards, referrals, authorizations, billing, claims, and compliance expectations.
Good working knowledge of Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook.
Ability to maintain provider trackers, issue logs, outreach documentation, meeting materials, and implementation status updates.

Responsibilities

Serve as the day-to-day point of contact for HRSN providers and community-based organizations participating in or preparing to participate in HRSN service delivery.
Coordinate provider onboarding with internal teams for contracting, credentialing, provider enrollment, administrative setup, and operational readiness.
Develop, coordinate, and deliver provider education on HRSN program requirements, workflows, documentation, referrals, authorizations, billing, claims, invoices, and reporting.
Maintain provider capacity logs and coordinate member assignments when a provider is not specified on a referral or authorization, or when the specified provider has reached servicing capacity.
Research and coordinate resolution of provider issues involving referrals, service eligibility, documentation, authorizations, billing, claims, payment, and program workflows.
Coordinate member and referral inquiries received through internal and external channels to reduce access barriers and support timely connection to covered HRSN services.
Work with HRSN Program leadership, utilization management, claims, provider operations, analytics, customer relations, and community partners to identify root causes and implement practical solutions.
Build and maintain collaborative relationships with HRSN providers, community stakeholders, and external partners to support implementation of HRSN benefits, including medical respite, nutrition supports, reentry services, housing supports, and CIS/CIS+ as applicable.
Support HRSN convenings, workgroups, trainings, and provider feedback loops to identify operational barriers and improve workflows as program guidance evolves.
Coordinate with internal teams so provider and community feedback informs program design, workflow refinement, communication materials, and rapid-cycle improvement.
Support required provider monitoring activities, including annual on-site visits for medical respite providers when applicable.
Maintain documentation of provider outreach, education, issue resolution, monitoring activities, and follow-up actions to support MQD expectations, audit readiness, and program integrity.
Escalate trends, risks, and unresolved barriers to HRSN Program leadership and support corrective action tracking when needed.
Perform other miscellaneous responsibilities and duties as assigned or directed.