Business Process Specialist

4 weeks ago


Bellaire, Texas, United States Texas Children's Health Plan Full time
Job Title: Business Process Specialist

Job Summary:

We are seeking a highly skilled Business Process Specialist to join our team at Texas Children's Health Plan. The successful candidate will be responsible for supporting and developing programs aligned with strategic health plan goals, conducting effective and timely assessments, and implementing processes and procedures that maintain a cost-effective provider network.

Key Responsibilities:

* Support and develop programs aligned with strategic health plan goals
* Conduct effective and timely assessments and equitable distribution of resources and assignments
* Educate and implement processes and procedures that maintain a cost-effective provider network
* Participate in Medical Policy, Reimbursement Committee, and other workgroups
* Facilitate process and/or system changes and propose, implement, and support quality control measures
* Perform reviews of current and newly implemented processes to ensure accurate reporting and deliverables
* Lead collaborations with other departments to meet compliance standards
* Manage process and workflow for audit response, contract adherence, and regulatory compliance
* Prioritize key project tasks and deliverables, and identify project risks, issues, and dependencies
* Demonstrate effective issue resolution skills
* Exhibit excellent written and verbal communication skills and the ability to manage several complex situations simultaneously
* Possess leadership, creativity, integrity, initiative, and sound problem-solving skills
* Pay attention to detail and follow-up

Requirements:

* 2 years of experience in a managed care organization (MCO) or related healthcare organization
* A Master's degree in Business, Health Care Administration, Public Health, Nursing, MIS, or an IS-related field may substitute for 2 years of required experience
* License: Not specified
* Certifications: Not specified
* Must-Have: Experience with Claims, Experience with Regulatory, Experience with Texas Medicaid, Experience in Tapestry (preferred), Bachelor's Degree in Business, Health Care Administration, Public Health, Nursing, MIS, or an IS-related field

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