Healthcare Services Analyst II

hmsacareers; Honolulu (HI); On-site; USD 65,000 - 90,000; Full time

Job summary

HMSA is seeking a health plan data analyst to research and respond to inquiries of low to mid complexity, analyze policy and benefit impacts, and support claims processing change initiatives. You will extract and analyze data with SQL or MicroStrategy and develop impactful documentation for policy development and implementation.

Candidates should have a bachelor’s degree (or equivalent) and at least two years of related experience, with strong verbal/written communication and organizational

Qualifications

• Bachelor's degree or equivalent combination of education and work experience.
• Two years of related work experience.
• Effective verbal, written communication skills.
• Excellent organizational and analytical skills.

Responsibilities

• Research and respond to low to medium complexity inquiries.
• Assess and analyze medical policy and benefit implications.
• Perform data extraction and analysis using SQL, MicroStrategy, or other tools.
• Develop documentation including cost/benefit and business impact analyses.
• Support implementation and monitoring of policy and workflow changes.
• Participate in software implementation and user requirement development.
• Attend HMSA Continuing Education training as assigned.
• Handle other duties as assigned.

Skills

Verbal communication

Written communication

Analytical skills

Organizational skills

Medical terminology knowledge

Health plan benefits knowledge

Education

Bachelor's degree or equivalent

Tools

Microsoft Office

Job description

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. Continuing Education:
   
   • Attends and successfully completes HMSA and Continuing Education training classes as assigned.
7. Other duties as assigned

1. Bachelor's degree or equivalent combination of education and work experience.
2. Two years of related work experience.
3. Effective verbal, written communication skills
4. Excellent organizational and analytical skills
5. Must possess working knowledge of medical terminology, anatomy, and health plan benefits.
6. Good working knowledge of Microsoft Office programs