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.
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?