Texas Children’s Health Plan
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 texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org. At Texas Children’s Hospital, diversity, equity, and inclusion are at the core of our values and mission for all of our 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.
Summary:
We are searching for aBusiness Process Specialist-- someone who works well in a fast-paced setting. In this position, you will support and develop programs aligned with Health Plan 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 for Texas Children's Health Plan.
Think you’ve got what it takes?
Responsibilities :
Research, develop, and implement a coordinated approach to ensure regulatory adherence for the department, through participation in Medical Policy, Reimbursement Committee, and other workgroups as needed, provides support for the facilitation of the process and/or system changes
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
Leads collaborations with other departments to ensure compliance standards are met
Process and workflow management for audit response, contract adherence, and regulatory compliance functions
Prioritizes key project tasks and deliverables and identifies project risks, issues, and dependencies.
Become a subject matter expert for all departments within the department
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
Create reporting documentation for Leadership
Leads meetings as needed between business owners, stakeholders, and project team members to communicate status, risks, and issues. Acts as a facilitator between the groups to resolve issues
Ensures consistent and frequent communication of project status with stakeholders
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
Provides analysis of reports for operational management and strategic planning
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
Qualifications:
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.
Required Bachelor's Degree and preferred Master's Degree in Business, Health Care Administration, Public Health, Nursing, MIS or an IS related field
2years’experience in a managed care organization or healthcare organization and preferred 5 years Master Proficiency in SQL, MS access, and data analysis within an MCO or healthcare organization
Thank you for your interest in applying for this job position.
Texas Children’s is excited to announce that we are transitioning to a new applicant tracking system. During this transition, from April 11-17, 2016 our application functions on our Careers website will be temporarily deactivated.
We sincerely apologize for this inconvenience. Visit us on Monday, April 18, 2016 to check out our new features and apply!