Provider Experience Technology Auditor

TX-HHSC-DSHS-DFPS•Austin, TX

2d•$6,378 - $9,167•Hybrid

About The Position

The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) division seeks a highly qualified candidate for the position of Provider Experience Technology Auditor (Technology Auditor III), reporting to the Director of Provider Experience for Operations. The MCS Operations department delivers infrastructure for both the managed care and fee-for-service delivery models within Texas Medicaid, one of the largest healthcare programs in the country, serving approximately 4 million Texans. Key department deliverables include claims resolution, acute care claims processing, provider enrollment, IDD Waiver Programs, Vendor Drug Program, and management of Medicaid Modernization. MCS is driven by its mission to deliver high quality, cost-effective services to Texans. The Provider Experience Technology Auditor Performs advanced information technology auditing work evaluating provider facing business processes, systems, and operational practices to identify opportunities that will improve the provider experience. Work involves reviewing technology-enabled workflows, provider enrollment processes, system usability, data integrity, internal controls, compliance practices, and operational performance measures. The auditor evaluates how providers interact with HHSC systems and processes.

Requirements

At least three years’ experience conducting audits, quality reviews, compliance reviews, technology assessments, process evaluations, data analysis, or operational reviews involving complex systems, programs, or business processes.
Experience evaluating technology systems, provider facing systems, customer experience processes, Medicaid operations, healthcare operations, enrollment processes, or public sector programs.
Graduation from an accredited four-year college or university with major coursework in any one or more of the following: information technology, computer information systems, business administration, public administration, healthcare administration, accounting, auditing, data analytics, or a related field. Relevant experience may be substituted for education on a year-for-year basis.
Knowledge of the general framework of state and federal laws and regulations relevant to publicly funded healthcare services such as Medicaid and CHIP.
Knowledge of principles and practices of information technology auditing, quality assurance, compliance monitoring, and internal control evaluation.
Knowledge of business process analysis, workflow evaluation, system usability review, and continuous improvement methods.
Skill in establishing plans and setting objectives and goals that support an overall business strategy.
Skill in identifying problems, evaluating alternatives, and implementing effective solutions.
Skill in research and analysis of policies and processes to ensure compliance with applicable regulations and standards.
Skill in communicating complex findings in a clear and professional manner.
Skill in establishing and maintaining effective working relationships with program staff, technology partners, vendors, and stakeholders.
Ability to conduct audits, reviews, and evaluations of provider facing systems and business processes.
Ability to analyze complex information and translate findings into practical recommendations.
Ability to assess provider experience concerns through process data, provider feedback, usability information, and operational measures.
Ability to identify risks, root causes, and opportunities for improvement.
Ability to prepare accurate reports, summaries, presentation, and corrective action updates.
Ability to manage multiple assignments and meet deadlines.

Nice To Haves

Certified Information Systems Auditor
Certified Internal Auditor
Certified Government Auditing Professional
Lean Six Sigma Green or Black Belt certification
Certified Information Systems Security Professional, or related certification.

Responsibilities

Conducts audits, quality reviews, and evaluations of provider facing technology systems, business processes, and operational practices. Reviews workflows, system functionality, internal controls, data integrity, compliance practices, and provider interaction points to identify risks, gaps, and opportunities to improve the provider experience.
Evaluates provider enrollment and Medicaid technology modernization processes, including PEMS and related systems. Reviews provider feedback, systems performance data, process maps, journey maps, dashboards, audit results, and key performance indicators to assess the effectiveness of provider facing processes.
Prepares audit work plans, reports, findings, recommendations, and corrective action summaries. Communicates clearly to leadership, program staff, technology partners, vendors, and stakeholders. Tracks corrective actions and supports continuous improvement efforts that improve provider satisfaction, system usability, and operational performance.
Researches and analyzes state and federal requirements, policies, procedures, standards , and best practices related to Medicaid operations, provider enrollment, technology auditing, quality assurance, data governance, and user experience. Recommends changes to policies, procedures, systems, and business processes.
Participates in meetings, workgroups, and project activities related to provider experience, system enhancement, Medicaid modernization, and operational improvement. Builds collaborative working relationships and provides timely responses to requests for information.
Other duties as assigned.