About the role
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
Job Summary
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.
Required Job Qualifications
- 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