Business Process Specialist - Provider Data Integrity - The Health Plan

Position: Business Process Specialist - Provider Data Integrity - The Health Plan

Job ID: 162621

Location: US-TX-Houston


Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p Monday - Friday

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 14,000 dedicated team members, visit for career opportunities. You can also learn more about our amazing culture at  At Texas Children’s Hospital, diversity, equity, and inclusion are at the core of our values and mission for all of the patients and families that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.


We are searching for a Business Process Specialist -- someone who works well in a fast-paced setting. In this position, you will support and develop programs aligned with strategic goals through effective and timely assessment and equitable distribution of resources and assignments, education and implementation of processes and procedures that provide and maintain a cost-effective provider network.


Think you’ve got what it takes?

Responsibilities :

Job Duties & Responsibilities

  • Research, develop, and implement a coordinated approach to ensure regulatory adherence for the department
  • Proposes, implements, and supports quality control measures related to practice and/or system changes that impact claims adjudication
  • Performs review of current and newly implemented processes to ensure accurate reports and/or other deliverables
  • Create documentation to support growth, ensuring that all processes are documented, and maintained as process improvements occur
  • Lead the changes process, create documentation for monitoring the change management, ensure that the team stays on task and timelines
  • Contributes to the identification and development of specific processes as needed supports the creation of educational training for staff to integrate processes into existing workflows
  • Drives performance excellence and accountability by developing relationships with and working across departmental boundaries to eliminate identified barriers to creating new and maintaining existing requirements


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.


Skills & Requirements

  • Bachelor’s degree required
  • 2 years’ experience in a managed care organization or related healthcare organization required
  • Master’s degree in business, health care administration, public health, nursing, MIS or an IS related field preferred
  • 5 years Master Proficiency in SQL, MS access, and data analysis within an MCO or healthcare organization preferred
  • A master’s degree in business, health care administration, public health, nursing, MIS or an IS-related field may substitute for 2 years of required experience

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