Responsible for assisting with the development, implementation, and management of operational processes that support quality and payment strategy initiatives (value-based payment and recognition programs for providers, hospitals, health centers, physician organizations, etc.). Serve as the primary project support for key operational processes and ensure that program issues and inquiries are resolved effectively and in a timely manner. Coordinate efforts with other key departments within HMSA, as well strategic partners and vendors.

• Program Coordination:
  • Develop appropriate communications for providers, hospitals, health centers, physician organizations, etc. related to program requirements and operations, such as:
    • Program guides
    • Payment notifications
    • Incoming provider documentation
  • Prepare and maintain critical policies and procedures documents for quality and payment strategy initiatives including, but not limited to, scorecard preparation, quality measure updates, internal and external data transfers, provider documentation, provider inquiries triage, and other operational activities.
  • Prepare reports, as needed, on status/progress of assignments for program team, HMSA leadership, and business partners.
  • Help identify and implement opportunities for process improvement, initiate changes and evaluate impact.

• Data management and analytics:
  • Maintain incoming provider documentation and provider inquiry database & logs.
  • Import, export, and validate vendor data and self-reported provider data (e.g., scorecards, supplemental data, medical records, etc.)
  • Validate internal and external data.
  • Assist with ongoing assessment of program measures to ensure alignment with national standards and corporate priorities.

• Cross-functional integration and communication:
  • Provide coordination and guidance to other departments & business partners in managing work to support efficient program operations.
  • Lead coordination of internal cross-departmental meetings.
  • Work directly with cross-departmental team members to complete tasks, facilitate communication, and provide status updates.
  • Work with the program team, other departments and external partners to monitor, collect, communicate, and distribute information. Communicate analyses, assessments, recommendations, and completed work product through professional written and oral reports and presentations.
  • Cooperate with other staff members to accomplish job duties, as well as assisting others in accomplishing theirs.

• Other Duties/Functions:
  • Performs all other miscellaneous responsibilities and duties as assigned or directed.
    • Serve as a team player and role model for other employees in the organization by always exhibiting traits of courtesy, caring, helpfulness, and respect
    • Conducts oneself in a service-oriented manner that is attentive, pleasant, cooperative, sensitive, respectful, and kind when dealing with members, visitors, the public, and all employees.
    • Assist with annual medical record review activity as needed