Research Coordinator

HMSA•Honolulu, HI

2h•Hybrid

About The Position

The Research Coordinator coordinates provider case resolution with internal business areas and responds to provider inquiries about claims, benefits, medium-complexity medical or payment policy questions, and provider appeals. The role investigates root causes, supports compliance with contract terms and servicing goals, and communicates directly with providers and their office staff to gather case information and explain resolutions. The coordinator represents Provider Services in cross-department workgroups, identifies provider impacts, and supports resolution of system issues and communications about system changes. The role develops business requirements and test cases to validate system changes and upgrades. It also creates provider education and communications, coordinates and maintains staff training, develops success measures, and maintains department workflows and procedures while participating in process improvements. Other duties may be assigned or directed.

Requirements

Bachelor's degree and two years of related work experience, or an equivalent combination of education and related work experience.
Effective verbal and written communication skills.
Basic working knowledge of Microsoft Office applications, including Word and Outlook/Email.

Responsibilities

Coordinate case resolution with internal business areas and respond to provider inquiries about claims, benefits, medium-complexity medical or payment policy questions, and provider appeals.
Research and resolve root problems to support compliance with contract terms and servicing goals.
Communicate directly with providers and office staff to gather case information and explain issue resolution.
Represent the Provider Services Department in cross-department workgroups and communicate provider impacts and perspectives to internal business areas.
Coordinate system issue resolution and facilitate internal and external communications about core system changes and issues.
Develop business requirements and test cases to validate that system changes and upgrades meet business requirements.
Develop provider and staff education and training materials, including workshop presentations and written materials; coordinate content with other business areas and obtain business approval.
Coordinate and develop provider communications to ensure information is provided accurately and on time.
Coordinate and maintain the Provider Servicing staff training program; train new employees and provide ongoing guidance and mentoring to research and field staff.
Develop and maintain success measurement activities that support department goals.
Develop, implement, and maintain department workflows and procedures; identify and participate in process improvements to increase operational efficiency.
Perform other miscellaneous responsibilities and duties as assigned or directed.