Provider Relations Analyst

Job Duties & Responsibilities

• Research, develop, and implement a coordinated approach to provider inquiries
• Lead collaboration with departments throughout TCHP to determine resolution options and propose solutions within regulatory requirements and compliance
• Review updates from the state pertaining to provider data to ensure compliance
• Analyze and validate provider information from multiple sources including TCHP systems, external systems and summary reports to ensure quality metrics, operational metrics and provider data are accurate
• Audits high-impact provider additions to the network, terminations from network and changes to ensure updates are complete and accurate
• Triage, document and respond to provider requests for information or resolutions
• Participate in TCHP improvement projects, programs, and initiatives to support the mission and strategic imperatives of the organization

Skills & Requirements

• High School Diploma or GED; Bachelor’s Degree preferred
• 4 years health care administration, managed care, or customer service experience
• A Bachelor’s degree in business administration, health education or related field my substitute for four (4) years of experience.

About Us

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.