Manager, Provider Operations

HMSA•Honolulu, HI

About The Position

Manage and provide direction to leadership and staff on provider network data and credentialing operations to ensure compliance with HMSA policies and procedures, state and federal regulatory requirements, and all applicable accreditation standards for credentialing HMSA providers across all lines of business, including Commercial, Medicare, Medicaid, and ACA products. Manage and work collaboratively with delegated credentialing entities and vendor partners, including offshore vendors, to ensure compliance with contractual, state, and federal requirements and accreditation standards. Serve as the primary point of contact for offshore vendor teams; establish clear expectations, provide guidance and feedback, monitor performance reports, and make operational adjustments as necessary to maintain required service and quality levels. Develop and mentor staff by providing direction on projects and tasks and by managing performance, career development, compensation, recruitment, and training. Design solutions, workflows, and infrastructure for provider network data to meet future market demands, including processes that effectively integrate onshore staff and offshore vendor resources. Build and maintain productive working relationships with internal and external parties, including offshore vendor partners: Conduct effective meetings and discussions to achieve consensus and identify actionable tasks. Collaborate with offshore vendor teams across time zones to ensure clear communication, timely handoffs, and alignment on priorities. Achieve service commitments from core and support functional areas. Prioritize, track, and manage deliverables. Ensure documentation and reporting are complete and meet compliance requirements. Perform other responsibilities and duties as assigned or directed.

Requirements

Bachelor's degree and five years of related work experience; or equivalent combination of education and related work experience.
Two years of supervisory/management experience or four years of team leadership experience.
Strong verbal and written communication skills.
Strong interpersonal skills.
Strong project management, planning, and organizational skills.
Demonstrated ability to build collaborative working relationships with vendor partners, including offshore teams.
Intermediate working knowledge of Microsoft Office applications, including but not limited to Word, Excel, Outlook, and PowerPoint.

Responsibilities

Manage and provide direction to leadership and staff on provider network data and credentialing operations.
Ensure compliance with HMSA policies and procedures, state and federal regulatory requirements, and accreditation standards.
Manage and collaborate with delegated credentialing entities and vendor partners, including offshore vendors.
Serve as the primary point of contact for offshore vendor teams, establishing expectations, providing guidance, monitoring performance, and making operational adjustments.
Develop and mentor staff, managing performance, career development, compensation, recruitment, and training.
Design solutions, workflows, and infrastructure for provider network data to meet future market demands.
Build and maintain productive working relationships with internal and external parties, including offshore vendor partners.
Conduct effective meetings and discussions to achieve consensus and identify actionable tasks.
Collaborate with offshore vendor teams across time zones to ensure clear communication, timely handoffs, and alignment on priorities.
Achieve service commitments from core and support functional areas.
Prioritize, track, and manage deliverables.
Ensure documentation and reporting are complete and meet compliance requirements.
Perform other responsibilities and duties as assigned or directed.