Texas Children's Hospital
Manager Reimbursement Systems Configuration (Telecommute)
Texas Children's Hospital, Houston, Texas, United States, 77246
Manager Reimbursement Systems Configuration (Telecommute)
Join to apply for the
Manager Reimbursement Systems Configuration (Telecommute)
role at
Texas Children's Hospital
We’re hunting for a
Manager of Reimbursement Systems Configuration (telecommuter/remote) , ready to be part of the best ranked children’s hospital in Texas and among the best in the nation. In this position, you will be responsible for the day-to-day operations of a production-driven team, maintaining state and regulatory requirements along with departmental SLAs.
Establishes, implements, and monitors quality control measures. Develops, tracks and reports performance and productivity metrics, proactively identifying trends and refocusing the direction of the team. Independently accesses workflows and processes for potential improvements and efficiencies. Works collaboratively with leadership and others from various areas across the health plan to evaluate and work cross‑functionally to implement new ideas and new strategies.
Job Duties & Responsibilities
Manage Business Operations Team.
Direct the work and direction of the team.
Direct department standards to meet and exceed state requirements.
Manage cross‑function work groups to create and implement best practices across multiple departments.
Report to leadership and executive leadership with quantifiable metrics on data quality.
Define department scope and review and sign off on policies and procedures.
Educate other departments on provider data use in all systems.
Establish, implement, and monitor quality control measures related to process and/or system changes impacting reimbursement and benefits.
Apply regulatory and systems knowledge to ensure regulatory adherence for provider reimbursement.
Apply reimbursement, regulatory, payment integrity, and systems functional knowledge to ensure regulatory adherence for provider reimbursement.
Quality management: coaching and developing.
Skills & Requirements
Bachelor's Degree required.
Other medical coding certificate preferred.
Five years project management experience required.
Three years management/leadership experience required.
Three years healthcare industry or MCO environment required.
Four (4) years configuration, payment integrity, reimbursement experience can substitute a bachelor's degree.
Prior hands‑on experience with configuration of the system for one of the following: provider contracts, fee schedules, or benefit engine.
About Us 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 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.
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.
Seniority level: Mid‑Senior level. Employment type: Full‑time. Job function: Finance and Sales. Industries: Hospitals and Health Care.
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Manager Reimbursement Systems Configuration (Telecommute)
role at
Texas Children's Hospital
We’re hunting for a
Manager of Reimbursement Systems Configuration (telecommuter/remote) , ready to be part of the best ranked children’s hospital in Texas and among the best in the nation. In this position, you will be responsible for the day-to-day operations of a production-driven team, maintaining state and regulatory requirements along with departmental SLAs.
Establishes, implements, and monitors quality control measures. Develops, tracks and reports performance and productivity metrics, proactively identifying trends and refocusing the direction of the team. Independently accesses workflows and processes for potential improvements and efficiencies. Works collaboratively with leadership and others from various areas across the health plan to evaluate and work cross‑functionally to implement new ideas and new strategies.
Job Duties & Responsibilities
Manage Business Operations Team.
Direct the work and direction of the team.
Direct department standards to meet and exceed state requirements.
Manage cross‑function work groups to create and implement best practices across multiple departments.
Report to leadership and executive leadership with quantifiable metrics on data quality.
Define department scope and review and sign off on policies and procedures.
Educate other departments on provider data use in all systems.
Establish, implement, and monitor quality control measures related to process and/or system changes impacting reimbursement and benefits.
Apply regulatory and systems knowledge to ensure regulatory adherence for provider reimbursement.
Apply reimbursement, regulatory, payment integrity, and systems functional knowledge to ensure regulatory adherence for provider reimbursement.
Quality management: coaching and developing.
Skills & Requirements
Bachelor's Degree required.
Other medical coding certificate preferred.
Five years project management experience required.
Three years management/leadership experience required.
Three years healthcare industry or MCO environment required.
Four (4) years configuration, payment integrity, reimbursement experience can substitute a bachelor's degree.
Prior hands‑on experience with configuration of the system for one of the following: provider contracts, fee schedules, or benefit engine.
About Us 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 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.
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.
Seniority level: Mid‑Senior level. Employment type: Full‑time. Job function: Finance and Sales. Industries: Hospitals and Health Care.
#J-18808-Ljbffr