Job Description: Revise and/or develop medical policies adopted from the BCBSA in conjunction with assigned medical... director and in accordance with Development and Approval of Medical Policy administrative policy; process includes appropriate...
staff regarding issues relating to administrative policies and procedures, medical policies, and researching and resolving...
Time - Moanalua Medical Center - OR Primary Location Honolulu, Hawaii Schedule Full-time Shift Day Salary... Support from American Heart Association Additional Requirements: Knowledge of medical terminology. Demonstrated...
such as HMSA's Medical Policy Manual, plan certificates and Guide to Benefits, mapping documents, product development documents... published by Blue Cross and Blue Shield Association related to program compliance; the Federal and/or state governments...
and service activities. Get ahead of the curve of known jeopardy accounts by strategically positioning the value in HMSA.... Prospect new HMSA groups to grow HMSA and USAble customer base in Hawaii. Meet goals, quotas and minimum activity standards...
to gain agreement from member to be compliant with routine provider appointments and other medical services to maintain... for removing barriers that affect service delivery, member satisfaction, cost, and ultimately the community's health. Leading...
for non-covered or nonparticipating provider services in addition to soliciting claims and other related medical information... to resolve them upon initial inquiry to best service the member as well as minimize the number of cases escalated to senior...
and conducts office site, facility, medical record and other clinical reviews as required in accordance with established standards...
plans. Coordinate, facilitate and conduct medical record reviews to support quality activities Performs...
's position and concerns to management and decision makers. Triages cases to resolve them upon initial inquiry to best service...
. Triage cases to resolve them upon initial inquiry/intake to best service members and reduce cases escalated to Case... internal and external customer service calls regarding member or provider appeals or grievance requests. Is able to handle...
Job Description: Delivers training programs using established materials and methodologies while ensuring consistent quality and adherence to learning objectives. Gathers data and feedback to support training needs assessments through su...
Job Description: Supports deployment of training initiatives including coordinating logistics and scheduling sessions; utilizes a variety of delivery methods/techniques. Assists in the creation and distribution of talent management comm...
Job Description: a. Research and Data analysis Provides quality, objective, and professional analysis of relevant topics. Gathers and analyzes information to identify trends, issues, innovations, and solutions for priority business ...
Job Description: Responsible for managing all aspects of the planning, execution, controlling, and closure of projects/programs. Responsibilities include, but are not limited to, the following: Receives high-level business requirements ...
Job Description: Identifies and mitigates potential regulatory risks associated with new product development Supports competitive and cost-benefit analyses by comparing actuarial features and pricing of competitor products Evaluates t...
Job Description: Design, deliver routine, variance, and ad hoc performance reports and analysis to Claims, Print & Mail, and Enrollment Program leadership that provides actionable insights and drives increased performance. Lead strategy...
Job Description: Job Description Evaluation: Administers job description process: Reviews job evaluation requests for new or revised job descriptions to determine appropriate job leveling and FLSA exemption status. Utilizes job evaluatio...
Job Description: Performs comprehensive reviews of assigned areas, including transactions, documents, records, and automated functions to ensure accuracy, adequate controls, and operational efficiency, in compliance with regulations Con...
Job Description: Demonstrates proficiency in bringing a cross functional perspective to complex business analysis activities and projects to support the implementation of corporate projects involving new systems and functions, and enhanc...