Senior Business Process Specialist

 
Position: Senior Business Process Specialist

Job ID: 153424

Location: US-TX-Bellaire

Department: BUSINESS OPERATIONS - ADMIN

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a-5p

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.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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
  • 4 years of experience in managed-care in a managed-care organization


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