Business Process Specialist

 
Position: Business Process Specialist

Job ID: 163205

Location: US-TX-Houston

Department: Claims - Administration

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5P

About Texas Children's Hospital

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 a Business 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 
  • 2 years’ 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 


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