Manager Of Business Systems Operations - Medicaid Provider Setup

Position: Manager Of Business Systems Operations - Medicaid Provider Setup

Job ID: 149639

Location: US-TX-Bellaire


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 (TCHP) is the largest Texas Medicaid managed care organization, and is part of the Texas Children’s healthcare system. Founded in 1996, TCHP is the nation's first health maintenance organization (HMO) created just for children and pregnant women. Our plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. Currently the Health Plan serves more than 450,000 members across three service areas (Harris, Jefferson, North East). Members of the plan receive care from our network of more than 4,000 primary care physicians, 8,000 specialists, and 110 hospitals. They can also receive care at The Center for Children and Women, a patient and family-centered medical home with two convenient locations for TCHP members who can have all their medical needs met in one place, receiving multiple services the same day. TCHP is a recognized leader at encouraging holistic care that empowers families to live healthier lives.   To join our community of 13,000 dedicated team members, visit for career opportunities.   You can also learn more about our amazing culture at


We are searching for a Manager of Business Systems Operations - Medicaid Provider Setup — someone who works well in a fast-paced setting. In this position, you'll be responsible for assisting with the interpretation of federal, state, and other regulations and requirements related to Medicaid and Children's Health Insurance Program (CHIP) benefits and reimbursement. You will determine system configuration needs based on federal and state guidelines, as well as medial policy decisions. Lastly, you will manage and guide benefit, provider, contract and prior authorization configurations, fee schedule updates, provider configuration, claim edits, and rate/code updates.


Think you’ve got what it takes?

Responsibilities :

  • Develops, tracks, and reports performance/productivity metrics, and assures direct reports are meeting established metrics
  • Provides guidance and direction for the implementation of medical policy decisions
  • Manages new configuration implementations and/or configuration changes, ensures that the requirements for implementations and changes are documented, appropriate testing is completed and signed-off
  • Reviews, interprets, and provides direction for new or existing federal and state regulations and requirements mandated by Health and Human Services Commission (HHSC), Texas Medicaid & Healthcare Partnership (TMHP), Texas Department of Insurance (TDI), and other governing bodies
  • Collaborates with department leaders to review and assess new functionality/capabilities based on system upgrades
  • Ensures that policies/procedures, standard operating procedures, desk-level procedures, and/or guidelines all adhere to Medicaid and CHIP regulatory requirements
  • Creates efficiencies that demonstrates cost/administrative savings, and  enhances overall stakeholder (member/provider/employee) satisfaction




  • High school diploma or GED
  • Bachelor’s degree in health care administration, business administration, or a related field
  • 5 years of health insurance payor systems, configuration management, and/or information systems experience
  • Minimum of 4 years of management/leadership experience

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