Establishes relationships with business partners and the IT organization in order to provide technical solutions to meet user needs and influence strategic initiatives. Responsible for leading the analysis of IT requirements, alignment of IT resources and processes in order to meet the clients' organizational needs, as well as the design of enterprise solutions. Responsib

Investigator Team Leadership and Support Perform Investigator staff oversight, and coaching on day to day investigation activities including, but not limited to FWA case reviews and approvals, regulatory referrals, documentation, reporting, overpayment processing and prevention. Facilitate and lead Investigator level meetings to resolve operational issues, brainstorm FWA

Leadership Identify, initiate, and manage organization wide projects to ensure that all HMSA's Medicare Program contractual obligations are met or exceeded. Manages necessary changes to existing systems, operations or workflows to address new/revised requirements of CMS/DHS/MQD. Structures work plans and project scope to deliver business impact on high priority issues. Ad

Prioritizes approved invoices and check requests according to payment terms. Familiarizes with company policies and navigating steps in Dynamics GP, Certify and CentreSuite. Verifies approver's level of authority to ensure that the cost center and the amount being charged are authorized. Follows through with requestor and obtains appropriate approval as needed. Validates

Quality Improvement Operations Provide direction and manage HMSA's overarching Quality Improvement program, including the oversight of staff and necessary resources required to design and implement programs related to compliance with accreditation, regulatory and program requirements (e.g., NCQA, Med QUEST, CMS, OPM, etc.). Oversee project teams and provide guidance to su

a. Project management and facilitation Develops and maintains project plans, timelines, and scope documents for strategy initiatives. Proactively manages deliverables, timelines, and budget Monitors and takes appropriate action to ensure various task and system related deliverables are accomplished in an accurate and timely manner. Develops strategies and tactics based on

a. Helps to lead and contributes to strategic design, implementation, and management of strategy roadmaps, strategic frameworks, and initiatives. Works with key stakeholders to strategically design and implement strategy initiatives with guidance from executive sponsors, subject matter experts, and other staff as needed Utilizes systems thinking to ensure strategies are d

Performance Proactively service and grow HMSA products and services through various methods including site visits, on line meetings, telephone and email correspondence, power point presentations, and one on one customer servicing. Protect HMSA's market share through the successful renewal and retention of assigned accounts by strategically aligning HMSA's value propositio

Support the development of new products and benefits by performing the analysis and coordinating the efforts of others to produce the necessary information to be used in decision making by HMSA leadership. Produce comprehensive assessments of proposed changes through collaborative efforts with internal partners and subject matter experts. Prepare financial, brand, regulat

Execute, monitor, and lead implementation of payment integrity strategy. Assess the success of payment integrity activities for continued alignment with organizational goals (e.g., Healthcare Cost Trend) and ensure expected results are being achieved. Communicating external teams' outcomes, data analysis, complex processes and action plans to internal teams. Provides vend

Coordinate and deliver training programs using an appropriate mode (in person or virtual) to provide understanding of department technology and workflows, relevant laws, and HMSA plans and benefits. Manage logistics of training including planning, scheduling, and preparation of necessary tools and materials. Assist the department with daily business operations and functio

Maintain thorough knowledge of HMSA's provider network and the business with focus on provider contracts and reimbursement methodologies while working collaboratively across departments and our vendor partners to identify, document and maintain business requirements necessary for successful implementation. Researches the current state of HMSA's systems to include QNXT & C

Assist the Director to implement Credit Union policies, procedures and practices which include the organization's financial goals, objectives, and budgets. Make business improvement recommendations and coordinate with the Director to seek approval from the Board of Directors. Facilitate, organize, and plan all board meetings, credit union annual dinners and annual busines

Cross Functional Project Team Participation Assist project staff and subject matter experts with the planning and implementation of project and sub project work efforts. Work with stakeholders in the initial project planning stage to help set project objectives and success measures. Provide expertise to project managers for business or data requirements as well as ongoing

Performance Develop and implement account plans to leverage employer groups' objectives and how HMSA products fit into their benefit program and help them to accomplish their business goals. Use exceptional selling skills to promote and implement products and services through various methods, including site visits, correspondence, telephone, email/internet, power point pr