About Texas Children's HospitalFounded 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 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.
We are searching for a Quality Auditor - Med Policy, Fee Schedules, Benefits, and Contracts - someone who works well in a fast-paced setting. In this position, you’ll review and evaluate the quality and effectiveness of the business operations department’s policies, procedures, processes, and system updates as they relate to member eligibility, provider setup, benefit/contract/edit configuration, and code/rate updates. You will also partner with managers on audit findings to ensure any identified errors are promptly and appropriately corrected, as well as any performance and/or training gaps are addressed. Finally, you will track and report quality metrics for the department and serve as the point of contact for audit inquiries.
For this position, we are searching for someone who can audit configurations for fee schedules, benefits, and contracts for Managed Care. The ideal candidate for this role is someone with strong configuration experience or previous experience auditing Managed Care configuration. Experience with QNXT and a previous background in Medicaid claims is also a plus. This role will also include providing training to staff to improve compliance with the department quality metric goals
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