Provider Experience Program Specialist VII

TX-HHSC-DSHS-DFPS•Austin, TX

1d•Hybrid

About The Position

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.The Provider Experience Program Specialist (Program Specialist VII) supports the Director of Provider Experience in MCS Operations by implementing a coordinated, division-wide strategy that strengthens and aligns provider experience across Texas Medicaid and CHIP programs.The Specialist performs highly advanced (senior-level) consultative work to ensure that provider experience is designed around provider needs and real-world experiences promoting systems for positive interactions across all touchpoints, including HHSC internal teams and contracted partners such as Texas Medicaid Healthcare Partnership (TMHP) and managed care organizations responsible for provider engagement. This position works under minimal supervision, with extensive latitude for the use of initiative and independent judgment.Texas Medicaid is one of the largest healthcare programs in the country, serving approximately 4 million Texans and relying on a broad network of medical, behavioral health, dental and long-term care services providers. These providers contract directly with HHSC/TMHP or through managed care organizations and are essential partners in delivering care. Anchored in its mission to provide high quality, cost-effective services, MCS recognizes that improving provider experience will enhance access, strengthens program performance, and ultimately improves outcomes for Texans we serve.The HHSC Provider Experience Team will focus on ensuring a positive and seamless experience for providers when engaging with HHSC and the Medicaid program, with an initial focus on enrollment and the Provider Enrollment Management System (PEMS) application. PEMS is a tool for providers to enroll, revalidate, re-enroll, or maintain their participation in Texas Medicaid or other state health-care programs. The purpose of the provider enrollment process is to ensure people and organizations who deliver Medicaid services have the appropriate qualifications for the services they deliver, are in good standing with relevant regulatory entities, are legally recognized entities, and have not been disbarred from participation in the program.The Provider Experience Team will gather feedback through surveys and direct provider feedback for prioritizing system enhancements and identifying useability improvements. This work will continue in systems beyond PEMS in the future as HHSC continues to advance Medicaid technology modernization goals. The goal of the Provider Experience Team is to increase provider satisfaction, build relationships, and encourage long-term loyalty.

Requirements

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 public administration and management techniques.
Knowledge of: Best practices related to customer and user experience.
Knowledge of: Statistical analysis processes; budget processes; research techniques; training and marketing techniques; and program management processes and techniques.
Skill in: Strong skills in analysis, research, and problem-solving.
Skill in: Excellent written and verbal communication skills tailored to diverse audiences.
Skill in: Strong interpersonal and relationship-building skills, especially across departments, external stakeholders, and contractors.
Skill in: Identifying measures or indicators of program performance.
Ability to: Gather, assemble, correlate, analyze, and synthesize facts and translating into clear communications and recommendations.
Ability to: Devise solutions to problems.
Ability to: Market programs.
Ability to: Prepare reports.
Ability to: Develop, evaluate, and interpret policies and procedures.
Ability to: Communicate effectively.
Ability to: Serve as a lead worker providing direction to others.
Graduation from an accredited four-year college or university with major coursework in any one or more of the following: public administration, public policy, business, social work, systems development and implementation, communications, or related field. Additional work experience may substitute for education on a year-for-year basis.
A minimum of three years’ experience in one or more of the following: health care administration, provider relations, customer experience, operations, stakeholder engagement, contract oversight, or related fields.
A minimum of three years’ experience in planning, developing, coordinating, and implementing major programs or improvement initiatives.

Responsibilities

Supports the Director of Provider Experience in implementing a coordinated, division-wide strategy to nurture a system of interdependent self-reinforcing practices that align employees, partners, processes, policies, and technology grounded around understanding provider needs and point of view.
Assists management in developing program policies, processes, and technology enhancements aligned with provider experience goals.
Provides guidance to staff in integrating new policies, processes, and technology into provider experience operations.
Prepares and evaluates budget requests to support Provider Experience Team priorities and resourcing needs to achieve division-wide strategies.
Works closely with internal agency teams (operations, policy, ombudsman, quality, contract management, provider relations, etc.) to align on provider-facing processes impacting provider experience.
Partners with contract management teams to support the integration of provider-experience expectations into managed care contracts, procedures, handbooks, guidelines, manuals, and performance measures.
Builds collaborative relationships with teams from managed care organizations, TMHP operations, and other contractors/vendors that engage with providers to promote improvements in provider experience.
Supports oversight, data review, and performance monitoring of provider engagement activities conducted by managed care organizations, TMHP operations, and other contractors/vendors that engage with providers.
Engages with advisory and provider/professional organizations to promote understanding, coordinate support, and stimulate interest in provider experience initiatives.
Coordinates data collection, organization, analysis, and reporting for provider experience initiatives.
Analyzes provider issues, escalations, and program themes to inform decision makers and drive policy or operational changes.
Prepares program findings, recommendations, briefing materials, and dashboards for leadership use in decision-making.
Establishes metrics and performance expectations. Evaluates effectiveness of programs and initiatives using metrics, data trends, and outcome monitoring.
Coordinates and implements root cause analysis and compliance activities within provider-facing processes.
Collects and synthesizes provider feedback from multiple channels (MCO call centers, TMHP help desks, HHSC teams, provider associations, stakeholder meetings, complaints, etc.).
Analyzes and develops process flow diagrams/journey mapping for routine provider interactions to identify bottlenecks and improvement opportunities.
Supports design and implementation of initiatives to reduce administrative burden and streamline provider interactions across the end-to-end experience.
Formulates engagement initiatives that address provider needs and reduces obstacles across their journey.
Participates in change management efforts related to legislative initiatives and other projects implementing new policies, processes, and technology enhancements having provider impacts.
Assists in supporting legislative and other projects with provider impacts by developing or reviewing for clear, provider-friendly communication materials, process explanations, and guidance documents used by providers.
Other duties as assigned