Texas Medicaid Operations Specialist - Hybrid Texas

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Job Summary

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

Preferred Job Requirements:

• 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)
• Working knowledge of the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM) and the Uniform Managed Care Contract (UMCC) requirements and applying UMCM requirements to operational processes, reporting, deliverables and , or compliance activities are compliant.
• 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
• 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

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards .

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan  subject to the terms and the conditions of the plan.

Flex employees are expected to be in the office a minimum of three days a week. Management will have discretion to modify an employee's weekly schedule for exigent circumstances.

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. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Base Pay Range $63,300.00 - $114,300.00

Exact compensation may vary based on skills, experience, and location.