MCO Liaison

TX-HHSC-DSHS-DFPS•Austin, TX

2d•$5,099 - $8,305•Hybrid

About The Position

The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Program Specialist VI (MCO Liaison) in the Provider Enrollment (PE) unit. Healthcare providers who want to participate in Texas Medicaid must enroll in the program and periodically revalidate their enrollment. The PE unit oversees the policies, operations, and systems that support the provider enrollment process.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.Under the supervision of the Provider Enrollment Manager, the Program Specialist VI will serve as the liaison between Provider Enrollment and the managed care organizations (MCOs) and perform highly advanced consultative and technical work related to PE operational program policies and processes in a dynamic and fast-paced environment. Work includes researching and interpreting program policies, procedures, rules, regulations, guidance, and standards with respect to provider enrollment, credentialing, and managed care. Develops PE guidance and communications for MCOs. Recommends changes to MCO PE related contract requirements. Responsible for supporting the development of new PE policies and updating existing policies related to MCOs. Provides technical assistance to program and PE staff, providers, and state Medicaid contractors regarding PE and credentialing. Responds to legislative and external inquiries and requests. Prepares complex written reports. Researches and resolves PE related provider complaints involving MCOs. Leads the PE MCO workgroup as a subject matter expert on the PE program. Leads special projects. Performs legislative bill analysis.

Requirements

Graduation from an accredited four-year college or university with major course work in information technology, business administration, or a related field. Experience and education may be substituted on a year-for-year basis.
At least two years’ experience working with managed care organizations (MCOs) is required.
One year of experience with customer escalations or customer relationship management is required.
Knowledge or experience with Medicaid provider enrollment or provider credentialing preferred.
Knowledge of Medicaid managed care.
Knowledge of Medicaid or other HHSC programs preferred.
Skill in developing accurate, clear, and succinct program policies.
Skill in analyzing, interpreting and evaluating laws, policies and procedures.
Skill in leading large workgroups and in making presentations.
Skill in using Microsoft Office applications.
Skill in verbal and written communication.
Proficient in web conferencing tools (i.e. GoToMeeting & Teams).
Ability to establish and maintain strong working relationships with stakeholders.
Ability to work in a dynamic and fast-paced environment.
Ability to interpret state and federal statutes, rules and regulations.
Ability to prepare complex written reports.
Ability to review and analyze contract documents and complex data sets.

Nice To Haves

Preferred three years’ experience researching, analyzing, developing and communicating policy to stakeholders.
Preferred three years’ experience analyzing state and/or federal statutes, rules and regulations.
Preferred three years’ experience leading large workgroups or special projects.
Preferred experience with healthcare IT systems.
Preferred experience with hosting webinars or virtual online meetings or events.

Responsibilities

Leads the PE MCO workgroup as a subject matter expert on PE policy and programmatic initiatives.
Prepares agenda, facilitates discussions, and maintains effective working relationships with MCO representatives.
Coordinates with MCOs on major initiatives including readiness reviews, technical changes, policy changes, and other major projects.
Coordinates with other HHSC areas involved in managed care.
Identifies operational, policy and technical impacts to MCOs, shares information with MCOs and coordinates to ensure successful implementation.
Solicits feedback from MCOs on proposed PE and policy changes.
Interprets policies, procedures, rules, regulations and standards related to PE to other program areas.
Performs legislative bill analysis.
Researches MCO contracts and processes.
Assists with development of PE policy as it relates to MCOs.
Subject matter expert on PE MCO related policy.
Analyzes state and federal legislative mandates to develop recommendations for policy changes.
Updates the HHSC Uniform Managed Care Manual (UMCM) and Uniform Managed Care Contract (UMCC) with PE program and policy changes.
Collaborates with other subject matter experts to align HHSC’s PE requirements with managed care credentialing requirements.
Plans, researches, coordinates PE program policies and rules that affect other HHSC program areas.
Responds to legislative and external inquiries and requests.
Prepares complex written reports, presentations and other PE program deliverables.
Presents MCO 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 MCOs with program updates.
Provides technical assistance to program and PE staff, providers, and state Medicaid contractor.
Serves as expert on managed care policies and processes that affect provider enrollment; provides consultative support to other staff on MCO policies and processes.
Recommends MCO contract updates for PE.
Performs contract oversight of the state Medicaid contractor and MCOs with respect to provider enrollment.
Leads projects involving multiple cross-functional stakeholders.
Leads and participates in operational projects affecting the unit.
Coordinates with other program areas with minimal oversight.
Serves as a lead team member providing direction to others.
May train others.
Other duties as assigned.
Assists the HHSC Agency with provider enrollment related complaints, escalations, and requests for information.
Provides accurate, comprehensive and timely responses to escalations and complaints.