Manager, Encounter Submissions

HMSA; Honolulu (HI); On-site; USD 80,000 - 110,000; Full time

Job summary

HMSA in Honolulu is seeking a professional to manage encounter submissions and enhance strategic decision-making. The role requires collaboration with leads on submission data and implementation of new solutions.

The ideal candidate will coordinate teams, ensure compliance with government regulations, and develop strategies for continuous improvement within the business operations.

Responsibilities

• Communicates with LOB leads and Governance Finance Director on the necessary information.
• Establishes schedule for meetings and deliverables.
• Supports audits of encounter data.
• Ensures encounter submission data is meeting requirements.
• Manages implementation of new solutions.
• Oversees data reconciliation and research.
• Analyzes project objectives and data summaries.
• Responsible for production, delivery, and efficacy review of reports.
• Coordinates activities with staff for implementation.

Job description

Encounter Submissions Management

• Communicates with LOB leads and Governance Finance Director on the necessary information and context for strategic business decision making.
• Establishes schedule for meetings and deliverables to complete needs of all 3 lines of business encounter submissions.
• Supports audits of encounter data and minimizes risks of findings from submission activities.
• Ensures encounter submission data is meeting requirements for risk adjustments as set by relevant government entities.
• Manages implementation of new solutions as needed.
• Oversees data reconciliation and research. Resolves issues with encounter data reported through vendor partners recommending or implementing corrective actions.
• Analyzes project objectives, data sources, methodology, and data summaries and findings.
• Responsible for production, delivery, and efficacy review of reports for internal and external audiences.
• Coordinates and prioritizes activities with internal and external staff for implementation and monitors work for accuracy.

Program and Team Management

• Coordinates work of the encounters submission workgroup, ES team, and ES vendor(s).
• Provides guidance and development to team members.
• Responsible for performance management and staffing.
• Builds business case for additional resourcing needs.
• Delegates some leadership to senior analysts and oversees outcomes and communication.

Continuous Improvement

• Develops strategies to improve encounter submission passthrough and communication of opportunities to business owners.
• Creates culture of continuous improvement and a working environment to support encounter submissions, financial analysis, and reporting for Government Finance.

Subject Matter Expertise

• Monitors and evaluates changes in the external/internal environment, making changes to staffing and workflows to adapt.
• Forecasts gaps in SME and requests investments in internal or external resourcing.
• Develops and implements changes to processes and procedures that optimize revenue.

Documentation

• Ensures complete documentation of program policies and procedures.

Miscellaneous Responsibilities

Performs all other miscellaneous responsibilities and duties as assigned or directed.