Provider Enrollment Manager

Job Description:

The Texas Health and Human Services Commission (HHSC) Medicaid & CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Provider Enrollment (PE) Manager. Healthcare providers who want to participate in Texas Medicaid must enroll in the program and periodically revalidate their enrollment. The PE unit oversees the policies, operations, and systems that support the provider enrollment process. The PE Manager is selected by and reports to the Director of Provider Enrollment within MCS Operations.

The ideal candidate thrives in an environment that emphasizes: teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy.

The manager performs work providing day-to-day management of the PE unit. Responsibilities include management of personnel and operations of this unit including performance evaluations, training, and hiring/termination of staff. The PE manager will also provide input on state, federal and agency rules and policies as they apply to the program; take part in projects; help develop PE program rules, policies and procedures; participate in contract development and compliance; develop and provide oversight of training plans; serve as a liaison between the department and other external and internal stakeholders such as provider associations vendors, and other state and federal entities; and monitor and report on the overall program health. Represents the agency at conferences, panels and stakeholder meetings. Reports program and project status to agency leadership.
 

Essential Job Functions:

25% Personnel Management – Interviews, hires, manages, conducts, and oversees staff training. Provides staff with work assignments, direction on responsibilities, information on performance expectations, and feedback. Conducts performance evaluations. Keeps staff informed about relevant departmental activities and decisions. Provides staff with tools and information needed to complete their responsibilities. Monitors staff attendance, reviews and approves leave and carries out other human resources activities. Recommends personnel actions and works with management and human resources as needed.

25% Operational Management - Manages the day-to-day operational activities of direct reports and their assigned tasks. Impalements effective evaluation tools to determine and measure progress towards meeting the goals and objectives of the program. Reviews management, fiscal, compliance and productivity reports against operational goals and identifies gaps. Oversees the development of training plans and deliverables to meet current and new program activities and initiatives. Reviews guidelines, procedures, rules, and regulations and monitors compliance. Reviews results of internal audits or reviews to provide direction and guidance.

20% Strategic Planning and Development - Provides analysis and insight to improve organizational performance, efficiency and effectiveness based on strategic goals and objectives. Implements new federal and state mandates on program objectives and executes on short and long-term initiatives for compliance. Implements and monitors program automation and compliance initiatives. Monitors and reports on Provider Enrollment’s compliance and alignment with performance metrics and strategic initiatives.

15% Project Management – Manages and/or contributes to the successful implementation of projects including development, management, and approval of project deliverables, resources, and status reports for internal and external use. Assigns resources to projects as appropriate while managing competing priorities. Identifies and monitors status of external projects that affect PE.

15% Technical/Communication Support – Represents the program by making presentations; providing information to leadership; collaborating with consumer and provider advocacy associations, managed care organizations, other areas of HHSC, HHSC contractors, and other state agencies and federal partners. Responds to requests by legislators, auditors, attorneys, and other officials. Coordinates with federal and state agencies to ensure program policies, standards and activities conform to federal and state requirements. Excellent verbal and written communications skills to effectively communicate with all levels of management and external and internal stakeholders.

Knowledge Skills Abilities:

Knowledge of:

• State and federal Medicaid program rules and policies.
• State and federal Medicaid provider enrollment processes preferred.
• Contract administration, oversight and compliance.
• Information technology systems, standards and practices.

Skill in:

• Running day-to-day operations of a team to meet business objectives.
• Strong analytical, tactical conceptual thinking, planning, and execution.
• Excellent verbal and written communication, capable of explaining complex information to a variety of stakeholders.
• Conflict resolution, problem-solving, and making sound judgments under pressure.
• Skill in written communications and presentations.

Ability to:

• Provide management and tactical direction in support of organizational objectives.
• Lead and manage teams through staff selection, staff development, and performance management.
• Work collaboratively across the organization with diverse teams and stakeholders to accomplish objectives.
• Balance team and individual responsibilities.
• Manage area operations involving people, information technology systems, and multiple vendor handoffs.
• Build and maintain strong partnerships with internal and external stakeholders.
• Continuously learn and adapt to new concepts and evolving business needs.
  
  

Registration or Licensure Requirements:
None  

Initial Screening Criteria:

Required:
- Graduation from an accredited four-year college or university with major coursework in public administration, public policy, business administration, health care administration, social work, communications, or a related field. Relevant work experience may substitute for education on a year-for-year basis.
- At least 3 years of experience serving in a management capacity that includes supervising staff.
- At least 3 years of experience working in Medicaid or related health services programs.
- Experience delivering technical and non-technical presentations to various audiences and stakeholders.
- Experience responding to formal inquiries such as legislative requests, audits, government open records requests, and executive correspondence.