What are the responsibilities and job description for the Texas Medicaid Operations Specialist - Hybrid Texas position at Health Care Service Corporation?
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This position is responsible for providing operational services, assistance, and program implementation and coordination for one or more of the day-to-day Medicaid operational functions, including Utilization Management (UM), Care Management (CM), reporting, compliance, billing, claims, enrollment, and customer service. This resource is responsible for resolving complex and/or escalated internal or external operational questions. Additionally, this position works with other areas of the organization on the development, testing, and implementation of program policies, business processes, reporting solutions, and system changes to ensure the state requirements of the plan are met. The role will have a particular focus on Texas Medicaid managed care operations, including interpreting and supporting requirements outlined in the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM) and applicable managed care contracts, while using data and reporting to monitor operational performance, identify gaps, and support compliance.
Required Job Qualifications
Exact compensation may vary based on skills, experience, and location
HCSC Employment Statement
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
To learn more about available benefits, please click https://careers.hcsc.com/totalrewards
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
This position is responsible for providing operational services, assistance, and program implementation and coordination for one or more of the day-to-day Medicaid operational functions, including Utilization Management (UM), Care Management (CM), reporting, compliance, billing, claims, enrollment, and customer service. This resource is responsible for resolving complex and/or escalated internal or external operational questions. Additionally, this position works with other areas of the organization on the development, testing, and implementation of program policies, business processes, reporting solutions, and system changes to ensure the state requirements of the plan are met. The role will have a particular focus on Texas Medicaid managed care operations, including interpreting and supporting requirements outlined in the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM) and applicable managed care contracts, while using data and reporting to monitor operational performance, identify gaps, and support compliance.
Required Job Qualifications
- Bachelor Degree in Business with 4 years’ experience OR 8 years of experience working in health insurance operations
- Experience in project development, implementation and execution skills
- Experience interfacing with internal clients, operations personnel
- Verbal and written communication skills and ability to represent Medicaid department at committee meetings
- Experience with interacting effectively with all levels of internal and external customers
- Experience managing multiple projects effectively
- Interpersonal, organizational and analytical skills
- Organizational and leadership skills
- Experience with managing contract provisions
- Experience in Project Management
- Direct experience supporting Texas Medicaid managed care operations, preferably within a Medicaid Managed Care Organization (MCO), healthcare services organization, delegated entity, or vendor supporting a Texas Medicaid population.
- Working knowledge of the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM) and the Uniform Managed Care Contract (UMCC) requirements to ensure that and the and experience interpreting or applying UMCM requirements to operational processes, reporting, deliverables and , or compliance activities are compliant.
- Hands-on experience with Texas Medicaid Utilization Management (UM) and/or Care Management (CM) operations.
- Experience working with or interpreting Texas Medicaid managed care contract requirements, including the relationship between contract requirements, UMCM guidance, and operational execution.
- Experience monitoring operational performance or compliance, identifying gaps, validating deliverables/data, and coordinating corrective actions or operational improvements.
- Strong reporting and data-analysis skills, including advanced Microsoft Excel; Power BI/dashboard development or reporting experience strongly preferred.
- Experience with managing contract provisions
- Experience in Project Management
- Ability to analyze complex Medicaid operational requirements and translate them into clear business requirements, processes, reporting, and actionable recommendations.
- Location: Richardson, TX or Austin, TX offices
- Schedule: This is a Flex (Hybrid) role: 3 days in office; 2 days remote.
- Sponsorship: Sponsorship is not available
Exact compensation may vary based on skills, experience, and location
HCSC Employment Statement
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
To learn more about available benefits, please click https://careers.hcsc.com/totalrewards
Salary : $55,900 - $123,500