Manager, Provider Operations

Hybrid Work Environment - Must reside on Oahu

Pay Range: $68,000 - $133,000, position is eligible for an incentive bonus

Note:

Individuals typically begin between the minimum to middle of the pay range

Directs and oversees the Provider Operations Business Analyst staff and the development and management of HMSA's end-to-end provider onboarding, credentialing, and database management processes and related operational functions. This includes oversight of multiple provider databases that support complex processes, including credentialing, claims processing, contract management, quality programs, and the provider directory. Responsibilities include administration of contracts for all providers participating in HMSA's provider networks.

Database management requires thorough knowledge of HMSA information systems and extensive coordination with HMSA executives and other departments to ensure consistency and accuracy with compliance requirements, audit procedures, and organizational policies and procedures. A core requirement of this role is working collaboratively with offshore vendor partners to ensure that outsourced provider operations functions are performed accurately, on time, and in alignment with HMSA standards.

• 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.

• 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.

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