Provider Services Management Analyst

TX-HHSC-DSHS-DFPS•Austin, TX

8d•$5,798 - $9,508•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 Management Analyst IV, reporting to the Director of Provider Services within MCS Operations Management. The Provider Services area performs and oversees operations that support healthcare providers that participate in the Medicaid program. The primary functions of Provider Services include: Oversight of claims processing, payment, appeals and recoupments; Management of provider enrollment; Management of electronic visit verification; and Operation of a call center to assist providers with service authorizations. The ideal candidate thrives in an environment that emphasizes: teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy. This position supports Provider Services by managing priority assignments, advising on emerging issues, and ensuring deliverables meet agency standards. It also serves as a key liaison across MCS, HHSC, and external stakeholders to coordinate complex assignments, represent Operations Management in cross-agency efforts, and support timely decision-making. In addition, the position leads and monitors projects, analyzes legislative and regulatory impacts, identifies policy and operational risks, recommends solutions, collects and analyzes data in areas such as workload, operational, business, and managerial practices, and contributes to process improvements and policy development.

Requirements

Graduation from an accredited four-year college or university with major coursework in public administration, public policy, business administration, health care administration, social work, communications, or a related field. Relevant work experience may substitute for education on a year-for-year basis.
Three years of experience conducting management analysis such as evaluating an organization's operations, systems, and finances to recommend ways to improve efficiency or conducting root cause analysis of operational failures and drafting mitigating corrective action plans.
Three years’ experience working in the healthcare industry.
Knowledge of Medicaid and CHIP operations, including key program functions such as provider enrollment, claims and encounters management, service authorization support, and electronic visit verification.
Knowledge of State and federal laws, regulations, and legislative processes affecting Medicaid and CHIP services.
Knowledge of Project management principles, methodologies, and best practices.
Knowledge of Operational improvement and process analysis methodologies.
Knowledge of Principals of organizational coordination, stakeholder engagement, and change management.
Skill in developing accurate, clear, and succinct communications, which can include: reports, white papers, executive memoranda and briefings, talking points, and presentations.
Skill in analyzing, interpreting and evaluating laws, policies and procedures.
Skill in leading large workgroups and in making presentations.
Skill in using Microsoft Office tools including: Outlook, Word, Power Point, Teams and Excel.
Skill in complex verbal and written communication.
Skill in web conferencing tools such as GoToMeeting & Teams.
Ability to synthesize complex information into clear summaries and recommendations.
Ability to manage projects, assignments, timelines, resource plans, and status reports.
Ability to coordinate complex assignments across teams, divisions, agencies, vendors, and external stakeholders.
Ability to communicate effectively with executive leadership, internal teams, and external partners.
Ability to think critically to identify problems, evaluate options, and recommend practical solutions.
Ability to support executive leadership with sound judgment, discretion, and professionalism.
Ability to manage multiple competing priorities in a fast-moving and dynamic environment.
Ability to establish and maintain strong working relationships with stakeholders.
Ability to work in a dynamic and fast-paced environment.
Ability to interpret statutes, state, and federal rules and regulations.
Ability to review and analyze contract documents and complex data sets.
Ability to conduct root cause analysis and formulate corrective action plans.

Nice To Haves

Experience with state government, legislative analysis, administrative rules, regulatory requirements, or public policy implementation.
Experience supporting executive leadership, senior management, boards, commissions, or other high-level decision-makers.
Experience with billing, claims processing, or authorizations systems or processes preferred.

Responsibilities

Interprets policies, procedures, rules, regulations and standards related to the program.
Performs legislative bill analysis.
Interfaces with other areas in HHSC, other State agencies, vendors, and CMS to help interpret rules and policy.
Provides technical and analytical assistance to the Provider Services area.
Reviews processes and workflows to identify and recommend areas for improvement.
Conducts root cause analysis and helps to develop corrective action plans when undesired situations occur.
Provides consultation and recommendations to division leadership that align with organizational objectives, policies and practices.
Works with internal and external stakeholders, including contracted vendors, to research and disposition complex provider questions and complaints.
Provides senior-level support to the Director of Provider Services and the Provider Services area.
Prepares executive‑level briefings, decision documents, memoranda, legislative responses, formal correspondence, presentations, and talking points.
Reviews deliverables submitted to the Director of Provider Services for completeness and conformance with agency standards, and works with staff to ensure documents are ready for review and approval.
Manages projects and assignments to ensure timely completion of work impacting the unit.
Develops and manages project charters, timelines, resource plans, status reports, and other deliverables.
Provides strategic leadership by leading the development of solutions, identifying necessary resources, and driving projects to meet agency objectives.
Uses critical thinking to identify solutions to complex issues and drive the implementation of the necessary changes.
Keeps sponsors informed of project status, risks and issues.
Leads or represents Provider Services in workgroups and meetings to disseminate information on Provider Services policy and programmatic initiatives.
Prepares agendas, facilitates discussions, and maintains effective working relationships with stakeholders.
Coordinates with stakeholders on major initiatives including workgroups, technical changes, policy changes, and other major projects.
Responds to legislative and external inquiries and requests.
Prepares complex written reports, executive summaries, presentations, talking points, and other program deliverables.
Presents program policy at meetings.
Participates in other workgroup meetings.
Communicates with industry stakeholder groups such as provider associations and health plan associations.
Drafts guidance and notices to providers with program updates.
Perform other duties as assigned to support operational priorities, strategic initiatives, and organizational objectives.