Texas Health Steps Provider Relations Representative

About the role

Under the supervision of the THSteps Program Supervisor with latitude for independent judgement and action, the Provider Relations Specialist is responsible for maintaining and growing the Medicaid provider pool in Texas. Performs moderately complex (journey-level) consultative services and technical assistance work. Provides consultative services and technical assistance to Texas Health Steps providers medical and dental, program staff, governmental agencies, community organizations, or the general public. Markets Specialized Health and Social Services program(s) to community and professional groups to encourage and/or improve interest in the program. Monitors and reviews participant compliance with Texas Health Steps program policies and procedures. Assists as first-line contact for Medicaid and non-Medicaid provider issues in regard to the THSteps program. Performs complex work in THSteps provider relations, recruitment and retention services in cooperation with Texas Medicaid Health Plan and Managed Care Organizations.

Responsibilities

• Provider Technical Assistance (45%) – Identifies and articulates provider issues, develops solutions, and implements strategies in cooperation with appropriate agency contract entities, regional staff and provider groups for the purpose of recruitment and retention of a provider base that is adequate to meet THSteps client needs. Provides technical assistance and coordinates/provides training for established providers, develops mechanisms for identifying provider assistance needs early and responding in a timely manner by appropriate referral or personal intervention in coordination with TMHP and MCO plans. Documents and initiates action on provider and consumer complaints. Telephonic and/or (occasional) face to face interaction to analyze provider's inquiry and/or complaint, recommend solutions and resolve the provider's concerns whenever possible on first call contact. Develops & maintains positive relationships with physicians, providers, and practice managers within the provider network. Identifies new areas for provider recruitment.
• Program Activities (35%) – Coordinates THSteps activities and maintains quarterly contact with identified partner entities to facilitate community support for program objectives, dissemination of THSteps program information and address program issues. Works in the community and with professional groups to coordinate, improve and stimulate interest in programs for children's health. Coordinate and prepare THSteps provider education quarterly meetings and workshops. Supports HHSC Texas Health Steps and other state agencies in promoting the EPSDT and compliance activities.
• Administrative Duties & Special Assignments (20%) – Attend program related workshops and in-services. Participate as a team member in improving program services. Conducts and or facilitates special projects for THSteps as directed by Regional Administration and/or THSteps Central Office. Assist with coordination of utilization reviews. Maintain statistical reports as required. Performs administrative duties as assigned. Maintains reporting delivery system outputs, and activities to identify gaps in resources. Actively participate and/or serve in a supporting role to meet the agencies obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location.

Requirements

• Must possess a valid Class C Texas driver license, or equivalent license from another state.
• Must be able and willing to travel a minimum of 60%.
• Must have their own reliable transportation and appropriate insurance to operate a motor vehicle.
• Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.

Qualifications

• Bachelor's degree from an accredited college or university in Business, Public Health, Social Work, or related field.
• One (1) year experience in provider relations, account management, or customer service.
• Five (5) years of relevant work experience may be used in lieu of degree.

Skills

• Techniques for collection (sampling methods), organization, analysis, and interpretation of data.
• Medicaid services, eligibility and related programs.
• DSHS and THSteps Program goals, strategies and provider requirements.
• Health care delivery systems and issues.
• Agency and program goals, operations, procedures, requirements and performance standards.
• Current Public Health trends and practices.
• Computer software (Microsoft Office Suite – Word, Excel, Access, PowerPoint, Outlook).
• TMHP policies and procedures.
• MCO plans in assigned HSR11 and its counties.
• Public speaking and presentations.
• Effective written communication.
• Negotiate with complex Medicaid provider systems, groups and individuals.
• Work independently.
• Compile professional reports and present findings of data in clear, concise way.
• Make assessments of THSteps Program issues and evaluate implications on a broad level and scope.