HRSN Community Partnerships Specialist

HMSA•Honolulu, HI

6d•Hybrid

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 and coordinates with internal teams on contracting, credentialing, provider enrollment, administrative setup, and operational readiness. It develops and delivers provider education on program requirements, workflows, documentation, referrals, authorizations, billing, claims, invoices, and reporting. The specialist coordinates provider capacity and member assignments, addresses provider and referral issues, and works with internal teams and community partners to resolve barriers to access and service delivery. The role builds relationships with providers and stakeholders, supports implementation of applicable HRSN benefits, and facilitates convenings, workgroups, training, feedback, and workflow improvements. The position also supports provider monitoring, including annual on-site visits for medical respite providers when applicable. It documents outreach, education, issue resolution, monitoring, and follow-up to support MQD expectations, audit readiness, and program integrity. The specialist escalates risks and unresolved barriers and supports corrective-action tracking, along with other duties as assigned.

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.
Working knowledge of Microsoft 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 for HRSN service delivery.
Support provider onboarding into HMSA’s network, coordinating contracting, credentialing, provider enrollment, administrative setup, and operational readiness with internal teams.
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 to HRSN providers when no provider is specified or the specified provider has reached 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 from internal and external channels to reduce access barriers and support timely connection to covered HRSN services.
Collaborate with HRSN Program leadership, utilization management, claims, provider operations, analytics, customer relations, and community partners to identify root causes and implement solutions.
Build and maintain relationships with providers, community stakeholders, and external partners to support implementation of applicable HRSN benefits.
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, communications, and rapid-cycle improvement.
Support required provider monitoring, including annual on-site visits for medical respite providers when applicable.
Document provider outreach, education, issue resolution, monitoring activities, and follow-up 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.