Texas Medicaid Operations Specialist (Hybrid)

About the role

HCSC is hiring a Texas Medicaid Operations Specialist in a hybrid role (3 days in the office, 2 days remote) at its Richardson or Austin office. The position provides operational services, assistance and program implementation and coordination for day-to-day Medicaid functions such as utilization management, care management, reporting, compliance, billing, claims, enrollment and customer service. It also resolves complex or escalated operational questions and helps develop, test and implement program policies, business processes, reporting solutions and system changes.

Key responsibilities

• Support Texas Medicaid managed care operations, including interpreting and supporting the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM) and managed care contracts
• Use data and reporting to monitor operational performance, identify gaps and support compliance
• Work with other parts of the organization on program policies, business processes, reporting solutions and system changes
• Resolve complex or escalated internal and external operational questions

Required profile

• Bachelor's degree in Business with 4 years of experience, or 8 years of experience in health insurance operations
• Experience interfacing with internal clients and operations personnel, and representing the Medicaid department at committee meetings
• Experience managing multiple projects and communicating verbally and in writing
• Preferred: experience managing contract provisions, project management, direct experience with Texas Medicaid managed care operations (ideally within an MCO), and strong reporting and data-analysis skills

Required skills

• Preferred: working knowledge of the UMCM and the Uniform Managed Care Contract (UMCC)
• Preferred: experience monitoring operational performance or compliance, validating deliverables and data, and coordinating corrective actions
• Preferred: advanced Microsoft Excel

What we offer

• Base pay range of $63,300 to $114,300, varying with skills, experience and location
• A role aligned with an annual incentive bonus plan
• Benefits include health and wellness benefits, 401(k), pension plan, paid time off, paid parental leave, disability insurance, tuition reimbursement and more