Healthcare Services Analyst I

hmsacareers; Honolulu (HI); On-site; USD 55,000 - 75,000; Full time

Job summary

HMSA in Honolulu, HI seeks a Healthcare Analyst I to support Research and Analysis, Benefit and Policy analysis, and New Code Implementation. You will respond to inquiries, utilize online information files and databases, and collaborate with clinical consultants, other Blue Cross/Blue Shield plans, and vendors.

You will learn to assess the business impact of new benefits and changes in medical or reimbursement policies, perform cost/benefit analyses, and prepare documentation to inform claims

Qualifications

• Bachelor's degree or equivalent combination of education and work experience.
• One year related work experience.
• Effective verbal, written communication skills
• Excellent organizational and analytical skills
• Good working knowledge of Microsoft Office applications.

Responsibilities

• Research and respond to low complexity internal and external inquiries.
• Use resources including online information files and databases, plus guidance from peers, interviews with internal departments and vendors.
• Assess business impact of new benefits and policy changes; conduct cost/benefit analyses; develop documentation for claims processing.
• Update and create CES pend resolutions and drive changes through work intake, cross‑department meetings, requirements review, testing validation and post‑implementation monitoring.
• Learn loading new codes (CPT, HCPCS, ICD-10) and prepare files for review and configuration implementation.
• Support audits of implemented policies and completed projects; identify cost increases and inequitable payments; document complex business scenarios for policy/workflow requirements.
• Attend HMSA Continuing Education training classes as assigned.
• Other duties as assigned.

Skills

Analytical skills

Verbal communication

Written communication

MS Office

Organizational skills

Education

Bachelor's degree or equivalent

Tools

Microsoft Office

Job description

1. Research and Analysis:
   
   • Research and respond to low complexity internal and external inquires.
   • Use a variety of resources including, but not limited to on-line information files and databases, peer guidance, interviews with internal departments including clinical consultants, other Blue Cross/Blue Shield Plans and vendors.
2. Benefit and policy analysis & implementation:
   
   • Learns to assess business impact of new benefits, changes in medical or reimbursement policies/guidelines and tactics assigned in strategic planning.
   • Learns to conduct 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 complexity project implementations and pend resolution updates.
3. New Code Implementation:
   
   • With the guidance of the Healthcare service analyst II, learns how to load new codes, 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.
4. Post-implementation trends and workflow improvements:
   
   • Learn how to 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.
5. Continuing Education:
   
   • Attends and successfully completes HMSA and Continuing Education training classes as assigned.
6. Other duties as assigned.

1. Bachelor's degree or equivalent combination of education and work experience.
2. One year related work experience.
3. Effective verbal, written communication skills
4. Excellent organizational and analytical skills
5. Good working knowledge of Microsoft Office applications.