Job Description

About Texas Children's Hospital

Founded in 1996, Texas Childrens 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 Childrens 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 Business Process Specialist -- someone who works well in a fast-paced setting. In this position, you will support and develop programs aligned with strategic goals through 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 the organization.

Think youve got what it takes?

Responsibilities :

* Research, develop, and implement a coordinated approach to ensure regulatory adherence for business operations
* Through participation in Medical Policy, Reimbursement Committee, and other workgroups as needed, provides support for the facilitation of process and/or system changes
* Process and workflow management for audit response, contract adherence, and regulatory compliance functions
* Support Business Operations to ensure continuous improvements and growth in both quality and processes
* Create documentation to support growth, ensuring that all processes are documented, and maintained as process improvements occur
* Leads meetings as needed between business owners, stakeholders and project team members to communicate status, risks and issues
* Contributes to the identification and development of specific processes as needed supports the creation of educational training for staff to integrate processes into existing workflows

Qualifications:

* Bachelors degree in business, health care administration, public health, nursing, MIS or an IS related field required
* 2 years managed care experience in a managed care organization required
* 5 years master proficiency in SQL, MS access, and data analysis within an MCO preferred
* A masters degree in business, health care administration, public health, nursing, MIS or an IS-related field may substitute for 2 years of required experience