New

Network Policy Analyst

TEKsystems
$33.65 - $36.06 / hr
life insurance, sick time, 401(k), retirement plan
United States, Hawaii, Honolulu
Feb 22, 2025
Healthcare: Network Policy Analyst Full-time, hybrid work environment Must live on Oahu, Hawaii 6 months contract to Hire Description The Network Policy Analyst is responsible for leading the resolution of Fee Reviews initiated by network providers to ensure compliance with requirements set forth by the Insurance Commission Division. The Network Policy Analyst is also responsible for participation in the successful planning, design, and management of the provider network to comply with compliance standards and adequacy requirements that range in scope from short-term medium-level importance to full coordination of Corporate Tactical Initiatives and Regulatory/Compliance Requirements. Fee Reviews * Lead the Fee Review Process, which includes analyzing and explaining complex policy and reimbursement issues to providers, Professional Reimbursement, and leadership * Prepare cases for Operations Management Committee decision-making and formal Fee Review Committee (practicing physicians) review, communicating with physicians (both verbally and in writing) regarding the outcome and rationale behind decisions and tracking all actions taken to respond to the inquiry to ensure compliance with company's contractual obligations with physicians and to support commitments made to the Insurance Commission Division. Network Design, Management and Execution * Participate in the assessment and establishment of network plans to monitor compliance with federal and state regulations, government program rules and sub-regulatory guidance, and internal policies and standards. This includes but is not limited to: * Identify available networks in applicable lines of business (commercial, Medicaid, and Medicare) and programs, and conduct network analysis to establish access and compliance requirements. * Assess needs and develop a project plan(s), including phases, work plans, deliverables, and expected outcomes. * Design network reporting templates or tools as needed and make sure that program documentation and reporting are complete and meet compliance requirements. Prepare project reports for management, partners, or others as required. * In collaboration with relevant business areas, gather business requirements to determine network program timeframes, staffing requirements, funding limitations, in addition to ongoing reassessment, reprioritization and/or modifications. * Manage deliverables and timeline. Direct and/or guide program and network related development activities performed by others. Review status reports prepared by project personnel to ensure project progresses on schedule within prescribed budget guidelines. * Resolve department project issues or issues assigned by management or team lead. Identify organizational strengths and weaknesses and suggests areas of improvement. Develop functional specifications and system design specifications for program development opportunities. Review and edit requirements, specifications, business processes and recommendations related to proposed solution. * Identify root causes of non-compliance, deficiency, or other irregularity. * Report on findings and observations, and corrective action plans. * Recommend improvements of varying complexities to strengthen operations in meeting network standards. * Participate on cross functional teams as a member or team lead. Network Monitoring and Oversight * Maintain and execute system for maintaining necessary documentation related to network access and compliance monitoring activities. * Provide oversight and provide department leadership on regular status reports on network monitoring activities. * Conduct process measurement review and analysis, program evaluation(s) and/or statistical analysis as needed. * Directs others to conduct data analysis or abstraction as needed. Requirements Deliverables * In collaboration with relevant internal teams, monitor and analyze new laws, rules, regulations, and guidelines as well as changes to existing rules & regulations related to network management. * Convert statutory language to network requirements for business areas. * Provide timely responses to RFPs and ensure compliance with new laws, rules, regulations, and guidelines for HMSA's provider network. * Performs all other miscellaneous responsibilities and duties as assigned or directed. Top Skills Details statistical analysis, Microsoft Office, communication and writing skills, presentation and interpersonal skills Additional Skills & Qualifications Bachelor's degree and four years of related work experience or an equivalent combination of education and related work experience. Strong analytical skills Excellent oral and written communication skills. Demonstrated competence in performing intermediate statistical analysis. Demonstrated presentation skills. Excellent multitasking and time management skills. Intermediate knowledge of Microsoft Office applications. Including but not limited to Word, Excel, PowerPoint, and Outlook. Pay and Benefits The pay range for this position is $33.65 - $36.06/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a hybrid position in Honolulu,HI. Application Deadline This position is anticipated to close on Feb 28, 2025. About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.