Senior Research Coordinator

HMSA • Honolulu, HI

5d

About The Position

1. Coordinates case resolution with internal business areas to respond timely
and accurately to provider inquiries regarding claims, benefits and highly
complex issues that include medical or payment policy questions and provider
appeals. Resolve root problems to ensure compliance with contract terms and
servicing goals. Communicates directly with providers and office staff to
develop case information and communicate issue resolution. Issues researched
and resolved are of the highest complexity.
2. Participates on cross department workgroups representing Provider Services
Department. Identifies impacts to providers and communicates the provider's
perspective to internal business areas. Coordinates system issue resolution
and is responsible to facilitate internal and external communications about
core system changes and issues. Develops business requirements and test
cases to validate system changes and upgrades meet business requirements.
3. Develops education and training material for providers and their staff
including workshop presentations and written educational material.
Coordinates content development with other business areas and gains business
approval. Coordinates and develops provider communications to ensure
information is available to providers timely and accurately.
4. Coordinates and maintains Provider Servicing staff training program. Train
new employees and supplements training with ongoing guidance and mentoring
to research and field staff. Develop and maintain success measurement
activities that support department goals.
5. Develops, implements and maintains Department workflows and procedures.
Identifies and participates in process improvements for greater operational
efficiency.
6. Trains and mentors other Research Coordinator(s) in the unit.
7. Ensures Research staffs have access to any tools available that will aid in
the execution of their functions. This includes working with other
departments to learn and assess the value of their tools and facilitating
training and access for Research team members.
8. All other duties as assigned.

Requirements

• Bachelor's degree and three years related work experience; or an equivalent amount of education and related work experience.
• Excellent verbal and written communication skills.
• Intermediate working knowledge of Microsoft Word and Outlook.

Responsibilities

• Coordinates case resolution with internal business areas to respond timely and accurately to provider inquiries regarding claims, benefits and highly complex issues that include medical or payment policy questions and provider appeals.
• Participates on cross department workgroups representing Provider Services Department.
• Develops education and training material for providers and their staff including workshop presentations and written educational material.
• Coordinates and maintains Provider Servicing staff training program.
• Develops, implements and maintains Department workflows and procedures.
• Trains and mentors other Research Coordinator(s) in the unit.
• Ensures Research staffs have access to any tools available that will aid in the execution of their functions.
• All other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees