Manager, Provider Operations

HMSA; Honolulu (HI); On-site; USD 120,000 - 170,000; Full time

Job summary

HMSA in Honolulu, Hawaii seeks a senior provider network and credentialing leader to oversee data quality and credentialing operations across Commercial, Medicare, Medicaid, and ACA products.

You will direct staff and collaborate with vendor partners to ensure compliance with HMSA policies, state and federal regulations, and accreditation standards, while driving improvements in processes and data infrastructure.

Responsibilities

• Lead and direct provider network data and credentialing operations to ensure compliance with HMSA policies and regulatory requirements.
• Collaborate with delegated credentialing entities and offshore vendors to meet contractual and accreditation standards.
• Serve as primary contact for offshore teams, set expectations, provide guidance, monitor performance, and adjust operations as needed.
• Develop and mentor staff on projects, performance management, career development, compensation, and training.
• Design workflows and infrastructure for provider network data to meet future market demands and integrate onshore and offshore resources.
• Build productive relationships with internal and external partners and lead effective meetings to drive actionable tasks.

Job description

Manage and provide direction to leadership and staff on provider network data and credentialing operations to ensure compliance with HMSA policies and procedures, state and federal regulatory requirements, and all applicable accreditation standards for credentialing HMSA providers across all lines of business, including Commercial, Medicare, Medicaid, and ACA products.

Manage and work collaboratively with delegated credentialing entities and vendor partners, including offshore vendors, to ensure compliance with contractual, state, and federal requirements and accreditation standards. Serve as the primary point of contact for offshore vendor teams; establish clear expectations, provide guidance and feedback, monitor performance reports, and make operational adjustments as necessary to maintain required service and quality levels.

Develop and mentor staff by providing direction on projects and tasks and by managing performance, career development, compensation, recruitment, and training.

Design solutions, workflows, and infrastructure for provider network data to meet future market demands, including processes that effectively integrate onshore staff and offshore vendor resources.

Build and maintain productive working relationships with internal and external parties, including offshore vendor partners

• Conduct effective meetings and discussions to achieve consensus and identify actionable tasks
• Collaborate with offshore vendor teams across time zones to ensure clear communication, timely handoffs, and alignment on priorities
• Achieve service commitments from core and support functional areas
• Prioritize, track, and manage deliverables
• Ensure documentation and reporting are complete and meet compliance requirements

Perform other responsibilities and duties as assigned or directed.