The Role
Lead provider reimbursement operations including methodology implementation for institutions, professionals, and ancillaries; manage staff; provide financial analysis and reporting for contracting and network access; participate in negotiations; ensure compliance with contracts and regulatory standards; coordinate fee reviews, audits, budgeting, and cross-functional projects; respond to ad-hoc data requests and represent the organization externally.
Summary Generated by Built In
Job Summary & ResponsibilitiesPreferred Qualifications
- 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
#LI-Hybrid
- 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.
Skills Required
- 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
- Knowledge in project management, planning, and organization
HMSA Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about HMSA and has not been reviewed or approved by HMSA.
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Healthcare Strength — Medical and dental coverage are described as solid, with preventive services and select zero‑cost features adding value in recent plan years. Employer-sponsored plans can have affordable premiums in certain groups and broad access options.
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Retirement Support — A 401(k) with company match and potential discretionary contributions forms a strong component of total rewards. Retirement support complements the core medical and dental package.
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Leave & Time Off Breadth — Paid holidays and PTO that increases with tenure provide meaningful time‑off flexibility. Time‑away benefits scale with service length.
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The Company
What We Do
The Hawaii Medical Service Association (HMSA), an independent licensee of the Blue Cross and Blue Shield Association, is a reliable name in Hawaii health care. Established in 1938, we are the largest and most experienced provider of health care coverage in the state. Over half of Hawaii’s population have chosen HMSA for their health care coverage. We are dedicated to providing quality, affordable health plans; employee benefit services; and worksite wellness programs. HMSA also offers a variety of programs, services and support to help improve the health and well-being of our members and community.
