Mgr Bus Systems Ops

 
Position: Mgr Bus Systems Ops

Job ID: 161317

Department: BUSINESS OPERATIONS - ADMIN

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

About Texas Children's Hospital

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.

Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, a second community hospital opening in 2017. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.

To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.



Summary:

We are searching for a Manager of Business Systems Operations - someone who works well in a fast-paced setting. In this position, you’ll be responsible for assisting with the interpretation of federal, state, and other regulations and requirements related to Medicaid and Children's Health Insurance Program (CHIP) benefits and reimbursement. You’ll also determine system configuration needs based on federal and state guidelines, as well as medial policy decisions, manage and guide benefit configuration, contract configuration, fee schedule updates, provider configuration, claims edits, rate/code updates, and prior authorization configuration as well as develop, track, and report performance/productivity metrics. You’ll ensure direct reports are meeting established metrics and frequently review processes, workflows, and policies/procedures to ensure they are accurate, current, and meet all regulatory requirements. Finally, you will work collaboratively with leadership and others from various areas across the health plan to evaluate and implement new ideas and strategies that impact benefits, provider setup, and reimbursement, while ensuring compliance with the above regulations and requirements. 

 

Think you’ve got what it takes?



Responsibilities :

  • Ensure benefit configuration, contract configuration, provider configuration, fee schedule updates, claims edits, rate/code updates, and prior authorization configuration are all performed efficiently, accurately, timely, and in compliance with all federal and state regulations
  • Provide guidance and direction on the implementation of medical policy decisions as they relate to benefits and reimbursement
  • Manage new configuration implementations and/or configuration changes that impact benefits and reimbursement
  • Assure that the requirements for the implementations and/or changes are thoroughly documented, appropriate testing is completed, and sign-off is obtained as needed
  • Develop, implement, and maintain a comprehensive documentation system/repository for business requirements, configuration change requests, testing plans and results, etc.
  • Remain current on Texas Medicaid Provider Procedures Manual (TMPPM), Uniform Managed Care Contract (UMCC), Uniform Managed Care Manual (UMCM), and other bodies of knowledge that impact Medicaid and CHIP benefits and reimbursement, and have a direct impact on medical policy decisions and potential system configuration changes


Qualifications:

  • High school diploma or GED required
  • Bachelor’s degree in healthcare administration, business administration, or a related field preferred
  • 5 years’ experience with health insurance payor systems, configuration management, and/or information systems required
  • 4 years’ experience in management/leadership preferred
  • Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s, unless approved for a medical or religious exemption


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