Demo

Healthcare Services Analyst II

HMSA
Honolulu, HI Full Time
POSTED ON 3/14/2025
AVAILABLE BEFORE 4/2/2025
  • Research and Analysis :
  • Research and respond to low to medium complexity internal and external inquires.

    • Is proficient at utilizing a variety of resources including but not limited to on-line information files and databases, Medicare / other plan guidelines, plan certificates, provider contracts.
    • Make recommendations and decisions independently.
    • Benefit and policy analysis & implementation :
    • Assess business impact of new benefits, changes in medical or reimbursement policies / guidelines and tactics assigned in strategic planning.

    • Initiate, develop, coordinate and implement cost / benefit analysis of claims processing.
    • Extract and analyze data using SQL, MicroStrategy and / or other tools as available.
    • Develop documentation, including cost / benefit and business impact analysis and recommendations to implement and / or improve claims processing.
    • Update and create CES pend resolutions.
    • Drive implementation of changes through writing of Work Intake Form, participation in multi-department meetings, contribution and review of requirements, validation of test cases, and post-implementation monitoring.
    • Focus on low to medium complexity project implementations.
    • New Code Implementation :
    • Act as lead in loading of new codes by following existing documented process and timeline for downloading, processing and importing new codes (CPT, HCPC, ICD-10, etc.).

    • Prepare and submit files for review and configuration implementation.
    • Review new codes in assigned categories, work with Medical Management and Configuration to ensure appropriate claims processing / editing based on new code review.
    • Post-implementation trends and workflow improvements :
    • Support audits of implemented policies and completed projects. Identify and investigate areas involving cost increases, uncontrolled payments and / or inequitable payments.

    • Identification and resolution of issues and trends as a result of researching and responding to implementation requests, problem reports, and inquiries.
    • Develop clear, concise documentation complex business scenarios. This documentation will be used to develop policy / project systems and workflow requirements.
    • Software implementation :
    • Participate in the unit's efforts to implement new projects, software or software modifications.

    • Participate in the development of user requirements, test scenarios, and test validation activities.
    • Continuing Education :
    • Attends and successfully completes HMSA and Continuing Education training classes as assigned.

    • Other duties as assigned

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