Provider Network & Credentialing Operations Lead

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

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.