Coordinate assignment of all provider enrollment and maintenance activities within a centralized repository, including the support of timely provider updates for the claims processing systems, contracting efforts for appropriate provider reimbursement and assisting HMSA staff in achieving NCQA policy requirements.
Duties and Responsibilities:
Receive all inquiries from providers and HMSA staff which are submitted to PDCA via mail, email and fax. Respond directly to email from the requestor informing of the receipt of the request.
Analyze incoming requests to identify appropriate PDCA staff in which to assign the provider maintenance and contracting efforts. Provide initial direction to providers who are seeking enrollment in the HMSA network.
Receive the credentialing committee’s approval of providers (Facility and Professional) prior to contracts being executed by HMSA Executives. Coordinate the execution of the agreements by HMSA Executives, to complete the enrollment of the provider and the assignment to the PDCA staff.
Initiate PDCA process upon request submitted by a provider, to support NCQA policy adherence between HMSA Membership and PDCA Field staff, for all providers who are terminating from a line of business or from the HMSA network.
Support QUEST reporting requirements ensuring timely submission of requested data and documentation.
Support TRICARE contracting and data submission efforts.
Produce weekly status reports for management review.
Other duties, as assigned.
High school diploma (or equivalent) and two years general work experience, one year of which is in public contact or physician’s office or related experience and/or training.
Intermediate working knowledge of Microsoft Office applications (Word/Excel/Outlook).
Hawaii Medical Service Association - 19 months ago
Hawaii Medical Service Association (HMSA) is Hawaii's largest health insurance company. The not-for-profit company serves more than...