Senior Manager, Provider Reimbursements

Hawaii Medical Service Association; Honolulu, Northern (HI, KY); Hybrid; USD 87,000 - 180,000; Full time

Job summary

Hawaii Medical Service Association (HMSA) in Honolulu offers a hybrid work environment requiring residency on Oahu. The position leads the Provider Reimbursements Department, developing methodologies and guiding major initiatives to improve provider experiences and financial performance.

You will supervise staff, manage budgets, coordinate audits, and partner with management on negotiations and reporting to support HMSA's strategic goals.

Qualifications

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

Responsibilities

• Oversee staff implementing Provider Reimbursement methodologies across institutions and providers.
• Provide management reports and analysis for decision making, physician and institutional contracting.
• Participate in provider negotiations to ensure costs stay within budget.
• Administer compliance with par provider contracts and internal controls.
• Lead department on corporate projects affecting HMSA's long-term goals.
• Recruit, train, and manage Finance staff; foster growth and accountability.
• Coordinate audits and monitor budget; implement control points for fee loading.
• Act as Lead Representative presenting HMSA's case externally to the Fee review committee.

Skills

Leadership

Communication skills

Project management

Data analysis

Financial reporting

Education

Bachelor's degree

Job description

**Hybrid Work Environment - Must reside on Oahu **

Pay Range: $86,500 to $179,500,position is eligible for an incentive bonus
Note: Individuals typically begin between the minimum to middle of the pay range

Provide supervision and development of the Provider Reimbursements Department staff. Develop, manage, and implement HMSA Provider Reimbursement methodologies to ensure corporate strategies and initiatives are achieved. Implement changes to improve and simplify operations throughout HMSA to improve all Provider experiences with HMSA. Envisions and develops fundamental concepts of highly abstract relationships, principles, practices; responsible for program assessment, initiation, planning, and execution to achieve business objectives.

Minimum Qualifications

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

Duties and Responsibilities

• 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
• 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.
• 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.
• 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.
• 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
• 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.
• 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.
• Perform all other miscellaneous responsibilities and duties as assigned or directed

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