Business Analyst II - Medicare Programs

HMSA
United States, Hawaii, Honolulu
818 Ke’eaumoku Street (Show on map)
Dec 10, 2024
Support the administration and management of the day to day operational activities needed to comply with CMS requirements and HMSA standards. Be knowledgeable on all CMS regulations and HMSA operational standards. This duty requires the analyst to: Ensure all HMSA's Medicare Program contractual obligations and requirements are met or exceeded in appropriate operational depts. Interpret CMS regulations and provide operational impact guidance to departments and HMSA's contracted vendors. Adjust existing systems, operations, and/or workflows to adapt to the ever-changing requirements of CMS and any identified deficiencies in current program quality and administration. Then monitor compliance via report and data validation. Monitor communications from CMS and determine if/how changes to operations are needed in applicable internal departments. Follow-up to ensure correct action was taken on a timely basis. Handle ad hoc questions, research issues, and provide assistance to departments to assess impact and determine best course of action. Complete administrative reports based on business needs, program compliance, plan performance, and as assigned. Advise the manager on significant matters pertaining to regulatory and reporting requirements, program compliance, or needed program changes. Resolve all member cases and ensure CMS timeliness and accuracy requirements are met. Conduct quality assurance and process improvement reviews to assess compliance and verify appropriate actions are taken. Monitor and track HMSA's compliance with CMS program standards, policies, and guidance through multiple sources, such as HMSA submitted reports to CMS, CMS generated performance metrics, and department self-reported issues. Coordinate, develop and help implement Medicare Program policies and procedures to operationalize CMS requirements affecting multiple departments. Maintain understanding of Medicare program operations as it relates to marketing, membership enrollment, claims processing, financial statements, customer service, provider contracting, quality improvement, utilization management, etc. Obtain policy clarifications/additional guidance, coordinate special administrative and operational requests, respond to CMS inquiries and requests for information, and coordinate CMS performance reviews. Participate in the development and implementation of required corrective action plans to address CMS audit and internal quality assurance review findings. Coordinate and monitor activities with appropriate department staff to ensure that corrective action plans are implemented timely and accurately. Performs all other miscellaneous responsibilities and duties as assigned or directed. #LI-Hybrid