Quality Auditor Jobs

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.

Summary:

We are searching for a Quality Auditor 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. A Quality Business Process Specialist is expected to have experience with technical competencies such as TFS, Visio, Microsoft Office and SQL.

Qualifications

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

• Become a subject matter expert for all areas within the Business Operations department.
• 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.
• Proposes implements, and supports quality control measures related to practice and/or system changes that impact claims adjudication.
• Leads collaborations with other departments to ensure compliance standards are met.
• 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.
• Performs review of current and newly implemented processes to ensure accurate reports and/or other deliverables.
• Prioritizes key project tasks and deliverables and identifies project risks, issues and dependencies.
• Create documentation to support growth, ensuring that all processes are documented, and maintained as process improvements occur.
• Create reporting and dashboards for Leadership.
• 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.