JOB DESCRIPTION

Job Summary
Responsible for successful oversite and implementation of the Texas Medicaid Directed Payment Program (DPP) and internal business projects and programs involving department or cross-functional teams of subject matter experts. Plans and directs schedules as well as tracks and monitors program payments to ensure accuracy and audits for accuracy. Monitors all aspects of the program including current and past fiscal year activities and implementation of annual program changes. May engage and oversee the work of external vendors. Assigns, directs and monitors system analysis and program staff. This positions’ primary focus is project/program management.
Job Duties
Active collaborator with people who are responsible for internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion.
Plans and directs schedules as well as project budgets.
Monitors the project from inception through delivery.
May engage and oversee the work of external vendors.
Focus on program accuracy and auditing configuration and outgoing payments
Focuses on process improvement, organizational change management, program management and other processes relative to the business.
Leads and manages team in planning and executing business programs.
Serves as the subject matter expert for the DPP program and leads programs to meet critical needs.
Communicates and collaborates with internal stakeholders at various levels to analyze and transform needs and goals into functional requirements. Delivers the appropriate artifacts as needed.
Works with operational leaders within the business to provide recommendations on opportunities for process improvements.
Creates business requirements documents, test plans, requirements traceability matrix, user training materials and other related documentation.
Generate and distribute standard reports on schedule
Maintain and lead program status meetings on a regular cadence, and any needed ad-hoc meetings, with all appropriate stakeholders

REQUIRED EDUCATION :

Bachelor’s Degree or equivalent combination of education and experience.

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES :

3-5 years of Program and/or Project management experience.
Operational Process Improvement experience.
Healthcare experience.
Experience with Microsoft Project and Visio.
Excellent presentation and communication skills.
Experience partnering with different levels of leadership across the organization.

PREFERRED EDUCATION :

Graduate Degree or equivalent combination of education and experience.

PREFERRED EXPERIENCE :

5-7 years of Program and/or Project management experience
Experience with creating and maintaining program and process documentation.
Strong organization and presentation skills with great attention to detail
Experience with data analysis, auditing, and payment integrity programs
Experience with Claims (primary and secondary), Provider Contracting, and Benefit Configuration processes.
Experience with Managed Care
Experience with TX Medicaid/CHIP and TX Directed Payment Programs (DPP).
Experience with QNXT and ClaimShark
Experience with Finance/Accounting/Payment Integrity/SAIs
Experience interpreting regulatory policy/guidance
Reporting skills- generation/monitoring/analysis
Experience working in a cross functional highly matrixed organization
Experience with SQL (optional)

Please refer the Job description for details