HRSN Community Partnerships Specialist
- Hiring from
- United States
- Work type
- Hybrid
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- 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.
- Bachelor's degree and four years of related experience in healthcare, Medicaid managed care, provider relations, community engagement, program operations, care coordination, social services, or a related field.
- Experience coordinating with providers, community-based organizations, members, or internal business partners to resolve operational issues and support program implementation.
- Strong relationship-building, communication, facilitation, and issue-resolution skills; ability to work effectively with providers, community organizations, members, internal teams, and government partners.
- Ability to communicate program requirements, workflows, and operational expectations clearly to external stakeholders with varying levels of Medicaid experience.
- Working knowledge of regulated healthcare program requirements, provider operations, documentation standards, referrals, authorizations, billing, claims, and compliance expectations.
- Good working knowledge of Microsoft Office applications to include Word, Excel, PowerPoint, and Outlook.
- Ability to maintain provider trackers, issue logs, outreach documentation, meeting materials, and implementation status updates.
