Job ID: EMO-1027865 Description:
Located in either Austin, Houston, Richardson, San Antonio, Waco Texas - this position is responsible for the oversight of Medicaid as it relates to network management: provider recruitment, credentialing, contracting, claims / servicing activities and education, monitoring reimbursement arrangements. Responsible for analyzing the networks regularly for provider accessibility and availability and network adequacy requirements according to Texas Medicaid Health Plan, reporting deficiencies; assessing the competitive position of the networks; and strategizing for competitive advantage within Medicaid arena.
Bachelor Degree and 3 years health care administration or managed care operations experience OR 7 years health care administration/managed care operations.
2 years network management experience for Texas Medicaid.
3 years management experience.
Experience and knowledge of Texas Medicaid Regulations requirements and regulations.
Financial acumen in health care administration.
Analytical and planning skills.
Negotiation and contracting skills.
Clear and concise verbal and written communication skills including presentation skills.
Experience with interacting with all levels of corporate personnel and providers.
Relationship building acumen to develop relationships with providers.
Ability to travel, including overnight stays
PREFERRED JOB REQUIREMENTS:
TMHP Texas Medicaid Health Plan regulations.
Proficient with State of TX UMCM, Uniform Managed Care Manual Guidelines.
Familiar with FCP - federal coder regulations, OIG Office of Inspector General.
Willing and able to travel up to 20%, include overnight stays.
Experience writing Policy & Procedures: strong written communication, regulatory interpretation and application and implementation, workflows.
Liaison for interdepartmental Committees, ex. quality, network, compliance, etc.
This position can be located in one of the following Texas locations: Austin, Houston, Richardson, San Antonio, Waco.
Relocation is not provided at this time.
Sponsorship is not provided at this time.
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Expertise Government Programs, Network Management / Provider Relations Job Type Full-Time Regular Location TX - Waco, TX - Richardson, TX - Austin, TX - San Antonio, TX - Houston