Business Process Specialist

3 weeks ago


Houston, Texas, United States IT Avalon Full time
Job Summary:

As a Business Process Specialist at IT Avalon, you will play a critical role in supporting and developing programs aligned with our strategic goals. You will be responsible for effective and timely assessment and equitable distribution of resources and assignments, education and implementation of processes and procedures that provide and maintain a cost-effective provider network for Texas Children's Health Plan.

Key Responsibilities:

Participate in Medical Policy, Reimbursement Committee, and other workgroups as needed to provide support for the facilitation of process and/or system changes.
Propose, implement, and support quality control measures related to practice and/or system changes that impact claims adjudication.
Perform review of current and newly implemented processes to ensure accurate reports and/or other deliverables.
Lead collaborations with other departments to ensure compliance standards are met.
Process and workflow management for audit response, contract adherence, and regulatory compliance functions.
Prioritize key project tasks and deliverables and identify project risks, issues, and dependencies.

Requirements:

Bachelor's Degree in Business, Healthcare Administration, Public Health, Nursing, MIS, or an IS-related field.
2 years of experience in a managed care organization (MCO) or related healthcare organization.
Master's degree in Business, Healthcare Administration, Public Health, Nursing, MIS, or an IS-related field may substitute for 2 years of required experience.

Preferred Qualifications:

Experience with Claims, Regulatory, and Texas Medicaid.
Experience in Tapestry (Preference).

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