Texas Health and Human Services
Specialty Health Provider Relations Specialist
Texas Health and Human Services, Austin, Texas, us, 78716
Specialty Health Provider Relations Specialist
Location: AUSTIN, TX Reports directly to the Administrative Services Manager for Specialty Health (SH). Performs advanced consultative and technical support for program staff, program providers, and other program partners. Serves as the primary point of contact for oversight of contracted partners in the Texas Medicaid and Healthcare Partnership (TMHP) for Specialty Health programs, regularly attending meetings and reporting developments to Specialty Health management. Regularly monitors provider experience and recommends improvements while working to increase the quantity of providers. Compiles, reviews, and analyzes provider data to verify accuracy of overall data and individual providers. Maintains and updates data in an internal dashboard to report on provider information, provider relations, and ongoing improvement efforts. Participates in program workgroups and serves as an expert resource on provider related issues. Essential Job Functions (EJFs) Leads coordination between Specialty Health and TMHP on issues related to program provider enrollment and business operations. Reviews, analyzes, and approves reported performance data related to TMHP operations. Identifies trends and patterns impacting contractors performance. Recommends solutions to address performance gaps and improve outcomes. Communicates program needs and priorities to ensure consistent support of SH programs. Responds to inquiries and supports provider enrollment. Serves as point of contact for inquiries related to program enrollment. Ensures providers understand and comply with rules, regulations, policies, and procedures to ensure successful enrollment in Specialty Health programs. Participates in program and external workgroups to represent provider needs, offering insights to support policy and enhancements. Serves as the technical expert for provider enrollment systems including the Provider Enrollment Management System (PEMS). Maintains tracking systems to effectively resolve identified errors. Regularly updates an internal system and dashboard reflecting provider data and concerns. Collaborates with the Administrative Services Manager to determine necessary solutions to enrollment roadblocks and present to management. Uses problem-solving techniques to generate solutions to resolve systemic or ongoing issues. Oversees and participates in information and fact gathering activities to prepare administrative reports and performs in-depth specialized research projects. Develops standards, policies, and procedures related to program enrollment and TMHP contractor oversight. Works to remove barriers to program enrollment and increase the number of providers enrolled in Specialty Health programs. Develops and maintains provider manuals in accordance with program rules. Coordinates with program policy teams in development of internal procedures as they relate to assigned duties. Other duties as assigned, including participating in and supporting the agencys disaster response or Continuity of Operations (COOP) activation. May require alternate shift patterns or locations.
Knowledge, Skills, And Abilities (KSAs)
Knowledge of local, state, and federal laws related to the program areas and public administration; enrollment processes; statistical analysis; research and problem-solving techniques; quality management and assurance activities; and administration techniques, training, planning and implementation. Skills in identifying measures or indicators of program performance, and in using computer systems, including the Microsoft 365 suite; effective written and verbal communication; developing and presenting to the public and other agencies. Ability to organize and manage multiple tasks with competing deadlines; interpret state and federal laws, regulations, rules, and policies; analyze data and produce reports; engage in crucial conversations; build and maintain professional relationships with internal and external stakeholders; serve as a lead worker providing guidance to others. Registrations, Licensure Requirements Or Certifications Current and valid Certified Texas Contract Manager (CTCM) certification, preferred
Initial Selection Criteria
2 or more years of experience in healthcare provider contracting, enrollment, or operational support. Experience in reviewing and reporting performance data.
Preferred Selection Criteria
Experience working with TMHP provider relations. Experience interpreting contract deliverables.
ADA Accommodations: In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodations during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the online application, contact the HHS Employee Service Center. If you are contacted for an interview and need accommodation, notify the person scheduling the interview. Pre-Employment Checks And Work Eligibility: Depending on program area and position requirements, applicants selected for hire may be required to pass background checks and other due diligence. Telework Disclaimer: This position may be eligible for telework. All HHS positions are subject to state and agency telework policies and to the discretion of the direct supervisor and business needs. Job Location City: AUSTIN Job Location Address: 701 W 51ST ST Employment type: Contract Seniority level: Mid-Senior level #J-18808-Ljbffr
Location: AUSTIN, TX Reports directly to the Administrative Services Manager for Specialty Health (SH). Performs advanced consultative and technical support for program staff, program providers, and other program partners. Serves as the primary point of contact for oversight of contracted partners in the Texas Medicaid and Healthcare Partnership (TMHP) for Specialty Health programs, regularly attending meetings and reporting developments to Specialty Health management. Regularly monitors provider experience and recommends improvements while working to increase the quantity of providers. Compiles, reviews, and analyzes provider data to verify accuracy of overall data and individual providers. Maintains and updates data in an internal dashboard to report on provider information, provider relations, and ongoing improvement efforts. Participates in program workgroups and serves as an expert resource on provider related issues. Essential Job Functions (EJFs) Leads coordination between Specialty Health and TMHP on issues related to program provider enrollment and business operations. Reviews, analyzes, and approves reported performance data related to TMHP operations. Identifies trends and patterns impacting contractors performance. Recommends solutions to address performance gaps and improve outcomes. Communicates program needs and priorities to ensure consistent support of SH programs. Responds to inquiries and supports provider enrollment. Serves as point of contact for inquiries related to program enrollment. Ensures providers understand and comply with rules, regulations, policies, and procedures to ensure successful enrollment in Specialty Health programs. Participates in program and external workgroups to represent provider needs, offering insights to support policy and enhancements. Serves as the technical expert for provider enrollment systems including the Provider Enrollment Management System (PEMS). Maintains tracking systems to effectively resolve identified errors. Regularly updates an internal system and dashboard reflecting provider data and concerns. Collaborates with the Administrative Services Manager to determine necessary solutions to enrollment roadblocks and present to management. Uses problem-solving techniques to generate solutions to resolve systemic or ongoing issues. Oversees and participates in information and fact gathering activities to prepare administrative reports and performs in-depth specialized research projects. Develops standards, policies, and procedures related to program enrollment and TMHP contractor oversight. Works to remove barriers to program enrollment and increase the number of providers enrolled in Specialty Health programs. Develops and maintains provider manuals in accordance with program rules. Coordinates with program policy teams in development of internal procedures as they relate to assigned duties. Other duties as assigned, including participating in and supporting the agencys disaster response or Continuity of Operations (COOP) activation. May require alternate shift patterns or locations.
Knowledge, Skills, And Abilities (KSAs)
Knowledge of local, state, and federal laws related to the program areas and public administration; enrollment processes; statistical analysis; research and problem-solving techniques; quality management and assurance activities; and administration techniques, training, planning and implementation. Skills in identifying measures or indicators of program performance, and in using computer systems, including the Microsoft 365 suite; effective written and verbal communication; developing and presenting to the public and other agencies. Ability to organize and manage multiple tasks with competing deadlines; interpret state and federal laws, regulations, rules, and policies; analyze data and produce reports; engage in crucial conversations; build and maintain professional relationships with internal and external stakeholders; serve as a lead worker providing guidance to others. Registrations, Licensure Requirements Or Certifications Current and valid Certified Texas Contract Manager (CTCM) certification, preferred
Initial Selection Criteria
2 or more years of experience in healthcare provider contracting, enrollment, or operational support. Experience in reviewing and reporting performance data.
Preferred Selection Criteria
Experience working with TMHP provider relations. Experience interpreting contract deliverables.
ADA Accommodations: In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodations during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the online application, contact the HHS Employee Service Center. If you are contacted for an interview and need accommodation, notify the person scheduling the interview. Pre-Employment Checks And Work Eligibility: Depending on program area and position requirements, applicants selected for hire may be required to pass background checks and other due diligence. Telework Disclaimer: This position may be eligible for telework. All HHS positions are subject to state and agency telework policies and to the discretion of the direct supervisor and business needs. Job Location City: AUSTIN Job Location Address: 701 W 51ST ST Employment type: Contract Seniority level: Mid-Senior level #J-18808-Ljbffr