About Texas Children's Hospital
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 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 Manager of Provider Experience – someone who works well in a fast-paced setting. In this position, you will manage and maintain procedures supporting the rules and regulations as set by all regulatory entities to ensure timely processing of regulatory requirements including timeframes, documentation and communication with providers pertaining to overall Provider Experience. Additionally, you will work in collaboration with a dedicated cross functional service tea, to on-going service improvements, understand, articulate, and resolve service impacts, and drive the overall provider strategic planning solutions.
Think you’ve got what it takes?
Job Duties & Responsibilities
- Supervises, collaborates, and provides direction to staff responsible for the processing of all Provider Complaints and Inquiries, and ensuring all documentation is processed within state guidelines, continuous communication with providers and ensure timely processing of provider complaint or inquiry
- Acts as an internal liaison for our client to resolve all issues related to Provider Experience including managed care issues, contract implementation, contract interpretation, and maintain positive relationships with providers throughout the process
- Represents Network Management at various meetings, both internal, and external
- Accountable for managing the external end-to-end provider experience for the overall service delivery related to problem resolution, accounts receivable, education, and communication
- Tracks and monitors internal metrics and service performance
- Responsible for collecting, analyzing, interpreting, and distributing reports to the Provider Experience Team and Executive Leadership to bring awareness around current state and future opportunities to improve the provider experience
- Ensures timely review and response to all calls, faxes, and emails received to the Provider Experience Team inbox and phone queue
- Oversees documentation of all calls in our client’s systems for internal department review and access as needed
- Creates and maintains a system to ensure phone coverage throughout the business week during business hours
- Assures compliance with all regulatory and accreditation rules and regulations as they relate to Provider Experience and coordinates responses to our client and Human Services provider complains with the Director of claims, Business Operations, and Provider Relations
Skills & Requirements
- Bachelor’s Degree
- 4 years of healthcare, managed care, or contracts experience
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