Specialty Health Provider Relations Specialist

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.

Brief Job Description:

Reports directly to the Administrative Services Manager for Specialty Health (SH), performing advanced consultative and technical support for program staff, program providers, and other program partners. Serves as the primary point of contact for oversight of contracted partners in the Texas Medicaid and Healthcare Partnership (TMHP) for Specialty Health programs, regularly attending meetings and reporting developments to Specialty Health management. Regularly monitors provider experience and recommends improvements while working to increase quantity of providers. Will compile, review, and analyze provider data to verify accuracy of overall data and individual providers. Maintains and updates data in an internal dashboard to report on provider information, provider relations, and ongoing improvement efforts. Participates in program workgroups and serves as an expert resource on provider related issues.

Essential Job Functions (EJFs):

(30%) Leads coordination between Specialty Health and TMHP on issues related to program provider enrollment and business operations. Reviews, analyzes, and approves reported performance data related to TMHP operations. Identify trends and patterns impacting contractor’s performance. Recommends solutions to address performance gaps and improve outcomes. Communicates program needs and priorities to ensure consistent support of SH programs.

(25%) Responds to inquiries and supports provider enrollment. Serves as point of contact from all sources for inquiries related to program enrollment. Ensures providers understand and comply with rules, regulations, policies, and procedures to ensure successful enrollment in Specialty Health programs. Participates in program and external workgroups to represent provider needs, offering insights to support policy and enhancements.

(20%) Serves as the technical expert for provider enrollment systems including the Provider Enrollment Management System (PEMS). Maintains tracking systems to effectively resolve identified errors. Regularly updates an internal system and dashboard reflecting provider data and concerns. Collaborates with Administrative Services manager to determine necessary solutions to enrollment roadblocks and present to management. Uses problem-solving techniques to generate solutions to resolve systemic or ongoing issues.

(15%) Oversees and participates in information and fact gathering activities to prepare administrative reports and performs in-depth specialized research projects. Is responsible for development of standards, policies, and procedures as related to program enrollment and TMHP contractor oversight. Works to remove barriers to program enrollment and increase the number of providers enrolled in Specialty Health programs. Develops and maintains provider manuals in accordance with program rules. Will coordinate closely with program policy teams in development of internal procedures as it relates to assigned duties.

(10%) Other duties as assigned including, but are not limited to, actively participating, and serving in a support role to meet the agency's obligations for disaster response or recovery; or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment or location.

Knowledge, Skills, and Abilities (KSAs):

Knowledge of local, state, and federal laws related to the program areas and, public administration; of techniques of enrollment processes; of statistical analysis processes; of research and problem-solving techniques; of quality management and assurance activities; of administration techniques, training, planning and implementation.

Skill in identifying measures or indicators of program performance and the use of a computer and applicable software; in using computer systems, electronic mail systems, programs of the Microsoft 365 suite or equivalent; in communicating knowledge effectively to a variety of audiences, both verbally and in writing; in developing and presenting presentations to the public and other agencies.

Ability to organize and manage multiple tasks with competing deadlines; to interpret state and federal laws, regulations, rules, and policies related to the programs; to identify problems, analyze all relevant information, identify possible solutions and select an appropriate solution; to serve as an expert resource during workgroups or team meetings; to analyze data and produce reports; to engage in crucial conversations to manage and resolve work-related issues; to communicate and work effectively with individuals and groups and to share knowledge with co-workers; to build and maintain professional relationships with both internal and external stakeholders; to develop and maintain professional relationships with both internal and external stakeholders; to serve as a lead worker providing guidance to others.

Registrations, Licensure Requirements or Certifications:

• Current and valid Certified Texas Contract Manager (CTCM) certification, preferred

Initial Selection Criteria:

• 2 or more years experience in healthcare provider contracting or health provider support.
• Experience in reviewing and reporting performance data.

Preferred Selection Criteria:

• Experience working with TMHP provider relations.
• Experience interpreting contract deliverables.

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework.  Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.