Senior Manager, Provider Reimbursements

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

Job summary

HMSA seeks a senior finance leader to oversee provider reimbursement methodologies and related operations in a hybrid Honolulu environment. You will manage a team, deliver management reports for contracting decisions, and lead cross-functional projects aligned with HMSA’s strategic goals.

Responsibilities include budget oversight, compliance with regulatory standards, and negotiating with providers to maintain cost targets. Excellent communication and project management skills are essential.

Qualifications

• Bachelor's degree and six years related experience in financial reporting and/or data analysis, or equivalent combination.
• Two years of supervisory/management experience.
• Effective written and verbal communication skills.
• Demonstrate knowledge in project management, planning, and organization.

Responsibilities

• Oversee management and staff responsible for implementation and administration of Provider Reimbursement methodologies, including Institutions, Professionals, and ancillary providers.
• Provide management reports and analysis needed for decision making, physician and institutional contracting, and ensuring adequate provider network access.
• Participate in provider negotiations to ensure that costs are within the anticipated budget.
• Administer operational activities to ensure compliance with par provider contracts.
• Lead department on large, corporate-wide projects and programs that affect the organization’s long-term goals.
• Plan, schedule, measure and coordinate projects and tasks for unit and other business areas; make decisions to control scope and resources.
• Establish and foster productive working relationships with internal and external parties; conduct meetings to achieve collaboration and consensus; prioritize, track, and manage deliverables.
• Assist in monitoring and planning for the department budget; coordinate internal and external audits and implement control points for fee loading.

Skills

Financial reporting

Data analysis

Project management

Planning

Organization

Leadership

Communication

Education

Bachelor's degree

Job description

1. Oversee management and staff responsible for implementation and administration of Provider Reimbursement methodologies, including, but not limited to: Institutions, Professionals, and ancillary providers.
   
   • Provide management reports and analysis needed for decision making, physician and institutional contracting, and ensuring adequate provider network access.
   • Participate in provider negotiations to ensure that costs are within the anticipated budget.
   • Administer operational activities to ensure compliance with par provider contracts
2. Serve as department leader on large, corporate-wide projects and programs that affect the organizations long term goals and objectives. Partner with management to determine projects/programs desired outcomes as it relates to corporate strategies.
3. Recruit, train, and manage staff spanning across all areas of the entire Finance department. Develop and foster personal growth, learning, and accountability of the staff.
4. Has oversight of the department's compliance policies, procedures, and internal controls in accordance with SSAE, CMS, MAR, SOC 2, BCBSA guidelines, and other regulatory requirements.
5. Plan, schedule, measure and coordinate projects and tasks for unit and other business areas. Make decisions to control scope and resources, prepare documentation and ensure work flows are in accordance with our par contracts; through use of effective communication skills. Acts as a Lead Representative, presenting HMSA's case externally to the Fee review committee.
   
   • Respond to ad-hoc data requests from management, executive staff, and external departments in relation to corporate goals and initiatives to HMSA's vision. Coordinates Finance duties for Physician fee reviews for all lines of business
6. Establish and foster productive working relationships with internal and external parties by:
   
   • Effectively conducting meetings and discussions to achieve collaboration, trust, and consensus
   • Achieving service commitments from core and support functional areas
   • Prioritizing, tracking, and managing deliverables.
7. Assist in monitoring and planning for the department budget. Coordination of all Internal and External audits and implementation of control points for fee loading internally and with partners.
8. Perform all other miscellaneous responsibilities and duties as assigned or directed

#LI-Hybrid

1. Bachelor's degree and six years related experience in financial reporting and/or data analysis, or equivalent combination of education and experience.
2. Two years of supervisory/management experience.
3. Effective written and verbal communication skills.
4. Demonstrate knowledge in project management, planning, and organization.