Texas Children's Hospital
For this position, we are searching for someone who can audit Medicaid Provider configurations/data. The ideal candidate for this role is someone with strong Medicaid Provider configuration or previous experience managing provider data. Experience with QNXT/Epic Tapestry and a previous background in medical claims is also a plus. This role will also include providing training to staff to improve compliance with the department quality metric goals.
Think you’ve got what it takes?
Responsibilities
- Collaborate with managers for eligibility, provider setup, and medical policy/configuration to develop an audit program to review and evaluate the quality, accuracy, and timeliness of system updates
- Clearly and concisely report audit findings on a frequent basis to managers and assist with identifying performance and training gaps for the team
- Ensure errors are identified and corrected quickly
- Create a tracking and reporting mechanism for audits and share findings with the managers
- Develop and track quality metrics for the department and report to leadership on a regular basis
- Develop and maintain policies and procedures for the departmental audit program
- Identify and report the process improvement opportunities for the department to increase efficiencies, performance, and quality
- Assist with the production of various reports regarding the department’s quality and performance
Qualifications
Being fully vaccinated against COVID-19 is required for all employees at Texas Children’s, unless approved for a medical or religious exemption.
- High school diploma or GED
- Bachelor’s degree in health care administration, business administration, computer science, or related field preferred
- 2 years’ experience in Medicaid managed care
- 4 years’ experience in health plan operations, and 4 years’ experience in health plan payor systems/applications
- 2 years’ experience in auditing/quality review/training preferred
Company Profile
Texas Children’s Health Plan
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.
At Texas Children’s Hospital, diversity, equity, and inclusion are at the core of our values and mission for the women and children that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization.
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.
To apply for this job please visit careers-texaschildrens.icims.com.