Senior Business Process Specialist - Health Plan/Managed Care

 
Position: Senior Business Process Specialist - Health Plan/Managed Care

Location: US-TX-Bellaire

Talent Area: Professional - Non-Clinical

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 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 Business Process Specialist - Health Plan — someone who works well in a fast-paced setting. In this position, you'll develop and implement strategies to ensure optimal organizational operations that support the development and maintenance of a network of hospitals, physicians, and other health care providers who provide care to the members of the Health Plan. You will continually develop management programs in response to analysis and research of managed-care trends and benchmarks as well as the strategic goals the organization. We are seeking someone with strong experience in managed-care and Health Plans

 

Think you’ve got what it takes?



Responsibilities :

  • Support and develop programs aligned with Health Plan strategic goals, through effective and timely assessment and equitable distribution of resources and assignments
  • Plan, develop, organize, direct, and implement a coordinated approach to ensure regulatory adherence for provider network operations
  • Ensure accuracy and integrity of enterprise website and provider portal information with updates on an ongoing basis
  • Oversee compliance with complaints and issues tracking and monitoring for corporate and regulatory communications
  • Develop collaborative approaches to addressing claims processing concerns and opportunities for unique corporate/provider partnerships such as hospital systems, delegates, LMHAs, LIDDAs, and LTSS
  • Conduct cost/benefit analysis functions as indicated, to directly impact utilization patterns for the business
  • Contribute to the identification and development of specific programs as needed for providers and members
  • Oversee the creation of educational training for staff to integrate applications into the existing framework


Qualifications:

  • Bachelor’s degree in business, health care administration, public health, or nursing
  • Master’s degree in health administration or business administration preferred
  • 6 years of experience in managed-care in a managed-care organization


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