Quality Auditor - Configuration

We are searching for a Quality Auditor - Configuration to support and develop programs aligned with Health Plan strategic goals through effective and timely assessments, data analysis, dashboard creation, education and implementation of processes and procedures that provide and maintain a cost-effective provider network for Texas Children's Health Plan. In this role you will be expected to have experience with technical competencies such as TFS, Visio, Microsoft Office and SQL

Qualifications

Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees unless approved for a medical or religious exemption.

• High school diploma or GED
• Bachelor's degree in health care administration, business administration, computer science, or related field preferred
• 2 years' experience in Medicaid managed care
• 4 years' experience in health plan operations, and 4 years' experience in health plan payor systems/applications
• 2 years' experience in auditing/quality review/training preferred

• Create reporting and dashboards for Leadership.

• Proposes implements, and supports quality control measures related to practice and/or system changes that impact claims adjudication.

• Performs review of current and newly implemented processes to ensure accurate reports and/or other deliverables.

• Leads collaborations with other departments to ensure compliance standards are met.

• Prioritizes key project tasks and deliverables and identifies project risks, issues and dependencies.

• Become a subject matter expert for all areas within the Business Operations department.

• Create documentation to support growth, ensuring that all processes are documented, and maintained as process improvements occur.

• Contributes to the identification and development of specific processes as needed supports the creation of educational training for staff to integrate processes into existing workflows.

• Drives performance excellence and accountability by developing relationships with and working across departmental boundaries to eliminate identified barriers to creating new and maintaining existing requirements.

• Must have excellent written and verbal communication skills, and the ability to interact with a wide variety of individuals and handle several complex situations simultaneously.Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.