Hybrid HRSN Eligibility & Claims Analyst (Hawaii)

HMSA; Honolulu (HI); Hybrid; USD 59,000 - 116,000; Full time

Job summary

HMSA in Hawaii seeks a HSRN Authorization and Claims Analyst for a hybrid role. You will manage non-clinical eligibility, authorizations, and claims processing support to ensure accurate and timely payments in line with MQD requirements and HMSA policies.

The role builds and maintains prior authorization programs and workflows, reviews referrals and documentation, and coordinates resolution of authorization, billing, and payment issues. Strong analytical and communication skills are essential.

Qualifications

• Bachelor's degree or equivalent with 4+ years in healthcare operations, Medicaid managed care, utilization management, prior authorization, or related fields.
• Experience reviewing eligibility, referrals, authorizations, and claims.
• Experience researching operational issues and coordinating resolutions.
• Familiarity with healthcare information systems and policy procedures.
• Knowledge of non-clinical prior authorization, eligibility verification, and claims processing.

Responsibilities

• Perform non-clinical eligibility review for HRSN services, reviewing referrals, authorizations, member eligibility, and required documentation.
• Create, update, and maintain authorizations and program records in Medecision and other systems.
• Support build and maintenance of HRSN prior authorization programs, workflows, and business rules.
• Apply benefit criteria and policies; refer clinical decisions to licensed reviewers.
• Monitor authorization inventory, aging, and due dates; escalate barriers to member access.
• Research and resolve authorization, eligibility, and system issues affecting members and providers.
• Develop test scenarios and participate in user acceptance testing and validation.

Skills

Analytical thinking

Documentation

Communication

Time management

MS Office proficiency

Education

Bachelor's degree

4+ years healthcare ops experience

Tools

Medecision

Claims processing systems

Data analysis tools

Job description

HMSA in Hawaii seeks a HSRN Authorization and Claims Analyst for a hybrid role. You will manage non-clinical eligibility, authorizations, and claims processing support to ensure accurate and timely payments in line with MQD requirements and HMSA policies.

The role builds and maintains prior authorization programs and workflows, reviews referrals and documentation, and coordinates resolution of authorization, billing, and payment issues. Strong analytical and communication skills are essential.