HRSN Community Partnerships Specialist

HMSA; Honolulu (HI); In loco; USD 65.000 - 90.000; Tempo pieno

Descrizione del lavoro

HMSA in Honolulu seeks a Provider Onboarding, Education & Network Support professional to serve as the day-to-day contact for HRSN providers and community partners, guiding onboarding and ensuring operational readiness for service delivery.

You will coordinate with internal teams on contracting, credentialing, enrollment, and documentation; deliver education on program requirements and workflows; and maintain records to support audit readiness and program integrity.

Mansioni

• Serves as the day-to-day point of contact for HRSN providers and community-based organizations.
• Supports provider onboarding into HMSA's network, coordinating contracting, credentialing, enrollment, and onboarding readiness.
• Develops and delivers provider education on HRSN requirements, workflows, referrals, authorizations, billing, and reporting.
• Maintains provider outreach, education, issue resolution, monitoring actions, and follow-up to support audit readiness.
• Escalates trends and risks to HRSN leadership and supports corrective action tracking.
• Performs miscellaneous responsibilities as assigned.

Descrizione del lavoro

1. HRSN Provider Onboarding, Education & Network Support
   • Serves as the day-to-day point of contact for HRSN providers and community-based organizations participating in or preparing to participate in HRSN service delivery.
   • Supports provider onboarding into HMSA's network, including coordination with internal teams for contracting, credentialing, provider enrollment, administrative setup, and operational readiness.
   • Develops, coordinates, and delivers provider education related to HRSN program requirements, workflows, documentation expectations, referrals, authorizations, billing, claims, invoices, and reporting.
2. Provider, Member & Referral Coordination and Issue Resolution
   • Maintain provider capacity logs and coordinate assignment of members to HRSN providers when a provider is not specified on the referral or authorization form; or if specified provider has reached servicing capacity
   • Researches and coordinates resolution of day-to-day HRSN provider issues, including questions related to referrals, service eligibility, documentation, authorizations, billing, claims, payment, and program workflows.
   • Coordinates member and referral-related inquiries received through internal and external channels to reduce access barriers and support timely connection to covered HRSN services.
   • Works with HRSN Program leadership, utilization management, claims, provider operations, analytics, customer relations, and community partners to identify root causes and implement practical solutions.
3. Community Stakeholder Engagement & Program Implementation Support
   • Builds and maintains collaborative relationships with HRSN providers, community stakeholders, and external partners to support implementation of medical respite, nutrition supports, reentry services, housing supports, CIS/CIS+, and other HRSN benefits as applicable.
   • Supports HRSN convenings, workgroups, trainings, and provider feedback loops to identify operational barriers and improve workflows as program guidance evolves.
   • Coordinates with internal teams to ensure provider and community feedback informs program design, workflow refinement, communication materials, and rapid-cycle improvement.
4. Provider Monitoring, Documentation & Compliance Support
   • Supports required provider monitoring activities, including annual on-site visits for medical respite providers when applicable.
   • Maintains documentation of provider outreach, education, issue resolution, monitoring activities, and follow-up actions to support MQD expectations, audit readiness, and program integrity.
   • Escalates trends, risks, and unresolved barriers to HRSN Program leadership and supports corrective action tracking when needed.
5. Performs all other miscellaneous responsibilities and duties as assigned or directed.