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Healthcare Services Analyst II

HMSA
United States, Hawaii, Honolulu
818 Ke’eaumoku Street (Show on map)
Aug 21, 2025

  1. Research and Analysis:


    • Research and respond to low to medium complexity internal and external inquires.
    • Is proficient at utilizing a variety of resources including but not limited to on-line information files and databases, Medicare/other plan guidelines, plan certificates, provider contracts.
    • Make recommendations and decisions independently.


  2. Benefit and policy analysis & implementation:


    • Assess business impact of new benefits, changes in medical or reimbursement policies/guidelines and tactics assigned in strategic planning.
    • Initiate, develop, coordinate and implement cost/benefit analysis of claims processing.
    • Extract and analyze data using SQL, MicroStrategy and/or other tools as available.
    • Develop documentation, including cost/benefit and business impact analysis and recommendations to implement and/or improve claims processing.
    • Update and create CES pend resolutions.
    • Drive implementation of changes through writing of Work Intake Form, participation in multi-department meetings, contribution and review of requirements, validation of test cases, and post-implementation monitoring.
    • Focus on low to medium complexity project implementations.


  3. New Code Implementation:


    • Act as lead in loading of new codes by following existing documented process and timeline for downloading, processing and importing new codes (CPT, HCPC, ICD-10, etc.).
    • Prepare and submit files for review and configuration implementation.
    • Review new codes in assigned categories, work with Medical Management and Configuration to ensure appropriate claims processing/editing based on new code review.


  4. Post-implementation trends and workflow improvements:


    • Support audits of implemented policies and completed projects. Identify and investigate areas involving cost increases, uncontrolled payments and/or inequitable payments.
    • Identification and resolution of issues and trends as a result of researching and responding to implementation requests, problem reports, and inquiries.
    • Develop clear, concise documentation complex business scenarios. This documentation will be used to develop policy/project systems and workflow requirements.


  5. Software implementation:


    • Participate in the unit's efforts to implement new projects, software or software modifications.
    • Participate in the development of user requirements, test scenarios, and test validation activities.


  6. Continuing Education:


    • Attends and successfully completes HMSA and Continuing Education training classes as assigned.


  7. Other duties as assigned

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