HRSN Provider Onboarding, Education & Network Support
Serves as the day-to-day point of contact for HRSN providers and community-based organizations participating in or preparing to participate in HRSN service delivery.
Supports provider onboarding into HMSA's network, including coordination with internal teams for contracting, credentialing, provider enrollment, administrative setup, and operational readiness.
Develops, coordinates, and delivers provider education related to HRSN program requirements, workflows, documentation expectations, referrals, authorizations, billing, claims, invoices, and reporting.
Provider, Member & Referral Coordination and Issue Resolution
Maintain provider capacity logs and coordinate assignment of members to HRSN providers when a provider is not specified on the referral or authorization form; or if specified provider has reached servicing capacity
Researches and coordinates resolution of day-to-day HRSN provider issues, including questions related to referrals, service eligibility, documentation, authorizations, billing, claims, payment, and program workflows.
Coordinates member and referral-related inquiries received through internal and external channels to reduce access barriers and support timely connection to covered HRSN services.
Works with HRSN Program leadership, utilization management, claims, provider operations, analytics, customer relations, and community partners to identify root causes and implement practical solutions.
Community Stakeholder Engagement & Program Implementation Support
Builds and maintains collaborative relationships with HRSN providers, community stakeholders, and external partners to support implementation of medical respite, nutrition supports, reentry services, housing supports, CIS/CIS+, and other HRSN benefits as applicable.
Supports HRSN convenings, workgroups, trainings, and provider feedback loops to identify operational barriers and improve workflows as program guidance evolves.
Coordinates with internal teams to ensure provider and community feedback informs program design, workflow refinement, communication materials, and rapid-cycle improvement.
Provider Monitoring, Documentation & Compliance Support
Supports required provider monitoring activities, including annual on-site visits for medical respite providers when applicable.
Maintains documentation of provider outreach, education, issue resolution, monitoring activities, and follow-up actions to support MQD expectations, audit readiness, and program integrity.
Escalates trends, risks, and unresolved barriers to HRSN Program leadership and supports corrective action tracking when needed.
Performs all other miscellaneous responsibilities and duties as assigned or directed.
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