Business Process Specialist - Apex Systems

Job#: 2050666

Job Description:

To support and develop programs aligned with Health Plan strategic goals through effective and timely assessment and
equitable distribution of resources and assignments, education and implementation of processes and procedures that provide
and maintain a cost effective provider network for Texas Childrens Health Plan.
• Through participation in Medical Policy, Reimbursement Committee, and other workgroups as needed, provides support for
the facilitation of process and/or system changes.
• Proposes, implements, and supports quality control measures related to practice and/or system changes that impact
claims adjudication.
• Performs review of current and newly implemented processes to ensure accurate reports and/or other deliverables.
• Leads collaborations with other departments to ensure compliance standards are met.
• Process and workflow management for audit response, contract adherence, and regulatory compliance functions.
• Prioritizes key project tasks and deliverables and identifies project risks, issues and dependencies.

Must demonstrate ability to achieve effective issue resolution.
• Must have excellent written and verbal communication skills, and the ability to interact with a wide variety of individuals
and handle several complex situations simultaneously.
• Must have leadership, creativity, integrity and initiative, and sound problem solving skills.
• Must provide attention to detail and follow up.

Expereince with Claims 
Expereince with Regulatory 
Expereince with Texas Medicaid 
Expereince in Tapestry (Preference)  

Required- Bachelors Degree- Business, Health Care Administration, Public Health,
Nursing, MIS or an IS related field.
Required- 2 years Experience in a managed care organization (MCO) or
related healthcare organization.
A Masters degree in Business, Health Care Administration, Public Health, Nursing, MIS or an IS-related field may substitute
for 2 years of required experience.

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [email protected] or 844-463-6178.