Provider Engagement & Performance Leader (Hybrid)

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

Job summary

HMSA in Hawaii seeks a Provider Pod Leader to drive collaboration across provider organizations, lead recurring Pod meetings, develop agendas, and coordinate with internal experts to advance performance. The role emphasizes data-driven discussion and accountability to improve outcomes across the network.

The position focuses on value-based performance management, including revenue cycle optimization, RAF/HCC coding opportunities, and cross-functional partnership with Revenue Cycle, Clinical

Qualifications

• Lead recurring Provider Pod meetings for assigned provider organizations.
• Develop meeting agendas and facilitate productive discussions.
• Coordinate participation from internal subject matter experts.
• Track action items and ensure accountability for completion.
• Aggregate data with the Senior Financial Analyst and the Senior Data Analyst.
• Present findings in the POD meetings to rank-and-file providers.

Responsibilities

• Lead performance reviews and action planning related to: Revenue cycle optimization and issue resolution
• Medicare STAR quality gap closure opportunities
• Risk Adjustment Factor (RAF) optimization
• Suspect condition validation and documentation improvement
• HCC coding opportunities
• Cost of care reduction initiatives
• Emergency Department utilization
• Hospital admissions
• Readmission reduction
• Specialist referral optimization
• Preventive care performance
• Clinical quality measures

Job description

HMSA in Hawaii seeks a Provider Pod Leader to drive collaboration across provider organizations, lead recurring Pod meetings, develop agendas, and coordinate with internal experts to advance performance. The role emphasizes data-driven discussion and accountability to improve outcomes across the network.

The position focuses on value-based performance management, including revenue cycle optimization, RAF/HCC coding opportunities, and cross-functional partnership with Revenue Cycle, Clinical