Texas Medicaid Operations Specialist - Hybrid Richardson, TX

Health Care Service Corporation•Richardson, TX

9d•$55,900 - $123,500•Hybrid

About The Position

This position is responsible for providing operational services, assistance, and program implementation and coordination for one or more of the day-to-day Medicaid operational functions, including Utilization Management (UM), Care Management (CM), reporting, compliance, billing, claims, enrollment, and customer service. This resource is responsible for resolving complex and/or escalated internal or external operational questions. Additionally, this position works with other areas of the organization on the development, testing, and implementation of program policies, business processes, reporting solutions, and system changes to ensure the state requirements of the plan are met. The role will have a particular focus on Texas Medicaid managed care operations, including interpreting and supporting requirements outlined in the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM) and applicable managed care contracts, while using data and reporting to monitor operational performance, identify gaps, and support compliance.

Requirements

Bachelor Degree in Business with 4 years’ experience OR 8 years of experience working in health insurance operations
Experience in project development, implementation and execution skills
Experience interfacing with internal clients, operations personnel
Verbal and written communication skills and ability to represent Medicaid department at committee meetings
Experience with interacting effectively with all levels of internal and external customers
Experience managing multiple projects effectively
Interpersonal, organizational and analytical skills
Organizational and leadership skills

Nice To Haves

Experience with managing contract provisions
Experience in Project Management
Direct experience supporting Texas Medicaid managed care operations, preferably within a Medicaid Managed Care Organization (MCO), healthcare services organization, delegated entity, or vendor supporting a Texas Medicaid population.
Working knowledge of the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM) and the Uniform Managed Care Contract (UMCC) requirements to ensure that and the and experience interpreting or applying UMCM requirements to operational processes, reporting, deliverables and , or compliance activities are compliant.
Hands-on experience with Texas Medicaid Utilization Management (UM) and/or Care Management (CM) operations.
Experience working with or interpreting Texas Medicaid managed care contract requirements, including the relationship between contract requirements, UMCM guidance, and operational execution.
Experience monitoring operational performance or compliance, identifying gaps, validating deliverables/data, and coordinating corrective actions or operational improvements.
Strong reporting and data-analysis skills, including advanced Microsoft Excel; Power BI/dashboard development or reporting experience strongly preferred.
Ability to analyze complex Medicaid operational requirements and translate them into clear business requirements, processes, reporting, and actionable recommendations.

Responsibilities

Providing operational services, assistance, and program implementation and coordination for day-to-day Medicaid operational functions.
Resolving complex and/or escalated internal or external operational questions.
Working with other areas of the organization on the development, testing, and implementation of program policies, business processes, reporting solutions, and system changes.
Focusing on Texas Medicaid managed care operations, including interpreting and supporting requirements outlined in the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM) and applicable managed care contracts.
Using data and reporting to monitor operational performance, identify gaps, and support compliance.