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Professional - Non-Clinical
Provider Relations Analyst
Bellaire, TX, US
We are searching for a Provider Relations Analyst -- someone who works well in a fast-paced setting. In this position, you will be responsible for provider data management/governance and inquiry research, response, and resolution for all provider groups in the TCHP network. This includes collaboration with other departments and a review of regulatory requirements. The position is responsible for comprehensive reviews of our provider data to identify areas of concern for TCHP's provider network, mainly in regard to TCHP's Delegated provider groups. The position interacts with physicians, directors, managers, and peers on a daily basis to gather the information required to complete their work. The position is responsible for partnering with their peers to complete major departmental projects including data research, investigation of issues, and development of Standard Operating Procedures.
Think you’ve got what it takes
Job Duties & Responsibilities
• Research, develop, and implement a coordinated approach to provider inquiries
• Lead collaboration with departments throughout TCHP to determine resolution options and propose solutions within regulatory requirements and compliance
• Review updates from the state pertaining to provider data to ensure compliance
• Analyze and validate provider information from multiple sources including TCHP systems, external systems and summary reports to ensure quality metrics, operational metrics and provider data are accurate
• Audits high-impact provider additions to the network, terminations from network and changes to ensure updates are complete and accurate
• Triage, document and respond to provider requests for information or resolutions
• Participate in TCHP improvement projects, programs, and initiatives to support the mission and strategic imperatives of the organization
Skills & Requirements
• Required High School Diploma or GED; Bachelor’s Degree preferred
• 4 years health care administration, managed care, or customer service experience
• A Bachelor’s degree in business administration, health education or related field my substitute for four (4) years of experience.
About Texas Children’s
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 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.
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.
