Provider Relations Rep, Sr

 
Position: Provider Relations Rep, Sr

Job ID: 149643

Location: US-TX-Bellaire

Department: PROVIDER RELATIONS RESPONSE

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p

About Texas Children's Hospital

The Texas Children’s Hospital system is the largest pediatric integrated care system and is an industry leader in pediatric population health.    Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children and pregnant women.  We are an Integrated Community System providing holistic care that empowers families to live healthier lives.  Texas Children's Health 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 state territories (Harris, Jefferson, North East), who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. To join our community of 13,000 dedicated team members, visit www.texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at www.infinitepassion.org

Summary:

We are searching for a Senior Provider Relations Representative — someone who works well in a fast-paced managed care setting. In this position, you'll be responsible for the regulatory compliance of the Provider Relations and Pharmacy department(s).

 

Think you’ve got what it takes?



Responsibilities :

Job Duties & Responsibilities

HOU123

  • Ensures regulatory requirement adherence
  • Maintains and updates provider communications as required by NCQA, TDI, HHSC, CMS and other regulatory agencies including provider manuals, HHSC reporting, quick reference guides, orientations
  • Manages provider/member concerns and complaints
  • Ensures that the organization meets all requirements for concern and complaint completion
  • Uses appropriate resources for research
  • Prepares and presents data on complaints, regulations, and upcoming Medicaid changes to Provider Relations staff and management
  • Works closely with management in maintaining health plan regulatory compliance


Qualifications:

Skills & Requirements

 

  • High school diploma or GED
  • 6 years of experience in a health care or managed health care setting required
  • A bachelor’s degree in business administration, health education, or related field may substitute for four years of the health care administration, managed care, or customer service experience
  • Knowledge of the managed health care environment
  • High level of proficiency with computer word-processing, spreadsheet, and database software
  • Exceptional written and oral communication skills, as well as a high level of interpersonal skills
  • Strong analytical skills to assess root cause analysis on identified variances
  • Ability to communicate possible solutions as well as alternatives to management


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