Mgr Business Operations

About Texas Children's Hospital

Summary:

The Manager of Business Operations will be responsible the for the day to day Operations of a Production driven team(s), maintaining State and Regulatory requirements along with departmental SLA's. Develops, tracks and reports performance. productivity metrics, proactively identifying trends and refocusing the direction of the team(s). Independently accesses workflows and processes for potential improvements and efficiencies. Works collaboratively with leadership and others from various areas across the health plan to evaluate and work cross functionally to implement new ideas and new strategies.

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.
• Bachelor's Degree in Healthcare Administration, Business Administration or related field
• 5 years experience in strategic planning and/or project management 
• 4 years experience in Management/Leadership experience (preferred)
• Experience within an MCO environment (preferred)

Job Duties & Responsibilities

• Manage the work and direction team
• Direct the Department standards to meet and then exceed any State Requirements
• Lead cross function workgroups to create and implement best practices across multiple Departments
• Report out to Leadership and Executive Leadership with quantifiable metrics on the quality of the data
• Define the Department scope and review and sign off on policies

• Strong knowledge of health plan functions, including, but not limited to benefit configuration, contract configuration, fee
schedule updates, claims processing, member enrollment and eligibility, EDI transactions, and utilization management.
• Knowledge of Texas Medicaid and CHIP products and the medical insurance industry.
• Highly skilled and proficient in applying technical principles.
• Demonstrated analytical, problem-solving, and research ability as evidenced by experience in the identification of business
requirements and making subsequent recommendations for implementing appropriate configuration solutions to address
business needs or problems.
• Strong change management skills.
• Excellent written and verbal communication skills.
• Ability to demonstrate success in developing partnerships to achieve outcomes.
• Ability to interact with internal and external stakeholders at different levels.
• Ability to effectively manage competing priorities and meet all deadlines.
• Evidence of leadership, creativity, integrity, and initiative.

• Facilitate communication and engage business partners on discussions related to configuration solutions for new
requirements.
• Lead cross functional work groups on configuration initiatives to improve efficiency of claims adjudication process.
• Provide organizational leaders guidance on configuration services, concepts, policies and procedures.
• Lead the Business Operations team participation on the Medical Policy Committee to ensure understanding of
requirements, possible system constraints and projected timelines.
• Deliver metrics, SLAs and inventory reports to Business Operations and Executive leadership as needed.
• Create presentations to illustrate the team’s progress, new initiatives and/or work plans.

• Manage resources successfully to prioritize, coordinate and deliver excellence in an accurate and timely manner.
• Establish clear and quantifiable short and long term goals for the individual staff and the team that fit business needs and
support organizational goals.
• Build and maintain bench strength
• Mentor staff on creating a career/professional development paths leveraging interests, experience and performance.
• Provide guidance to staff through performance review communications to convey expectations, achievements and/or area