Provider Relations Representative

TX-HHSC-DSHS-DFPS

1d

About The Position

Under the direct supervision of the Texas Health Steps (THS) Program Supervisor and overall direction of the Specialized Health & Social Service Program Manager performs moderately complex (journey-level) consultative services and technical assistance to program staff, community organizations and THS
Providers. The Program Specialist II will conduct Texas Health Steps program activities which include Provider Relations duties of recruitment, retention and referral services with medical and dental THS providers, Serve as a liaison with THS providers, the Medicaid claims contractor, Managed Care Organizations (MCOs) and DSHS staff. Conduct provider relations duties that include consultative service by resolving provider enrollment and billing issues, policy clarifications and technical assistance. Participates in program planning, development and implementation of provider relations strategies to promote and support the THS program, increase the number of providers who accept Medicaid and participate in the THS program. Assists with the development of surveys, analyzes survey data and prepares comprehensive administrative reports. Assist with the development and presentation of education programs and coordinate program activities for community and professional groups. Actively participate and serve in a supporting role to meet the agency’s 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

• Graduation from an accredited four-year college or university with a Bachelor’s degree in human services, public health, education, social work, or a related field.
• Experience working in the healthcare, public health, or human services field.
• Experience conducting trainings, presentations, or providing technical assistance to providers, partners, or community stakeholders.
• Experience coordinating or supporting community outreach activities, events, or projects.
• Experience using computers and related software, including Microsoft Office applications such as Word, Excel, PowerPoint, and databases.
• Ability to travel up to 60% of the time, including occasional overnight travel.
• Ability to work within Public Health Region 9/10.
• Knowledge of Health & Human Service Medicaid programs, Medicaid Managed Care and Medicaid Managed Care Organizations
• Knowledge of public health and public health practices.
• Knowledge of recommended medical developmental screenings for children birth to 20 years.
• Knowledge of recommended dental screenings for children birth to 20 years
• Skill in public speaking
• Skill in oral and written communication
• Skill in adult training methods
• Skill in analyzing and devising solutions for problems identified
• Skill in interpreting and researching policies, procedures and regulations
• Skill in working with community agencies, groups or coalitions
• Skill in working independently, to organize workload, establish priorities and complete assigned tasks
• Skill in Microsoft Office Products
• Ability to interpret and apply program policy
• Ability to work in teams and take direction from supervisors
• Ability to establish and maintain effective work relationships with internal and external clients and colleagues
• Ability to develop training materials

Responsibilities

• Provides education and updates to retain existing and new medical, dental and case management providers; conduct education activities to community stakeholders regarding THS and Medicaid Services.
• Makes consultative to providers to discuss program issues, updates about programs, conduct trainings and/or assist providers with interpreting program policies and procedures.
• Assist providers with provider issues or enhance the knowledge of THS providers around program policy, requirements and procedures.
• Collaborates, communicates and assists with Managed Care Organizations (MCO’s) and Texas Medicaid (TMHP) for providers regarding billing issues.
• Escalates complex problems to central office timely to meet the needs of the provider.
• May assist medical and dental providers in the resolution of client related problems with community resources for referrals.
• Assists with compiling, analyzing and reporting of the THS activities to meet regional program goals and objectives and reporting to Program Manager.
• May assist Providers with consumer complaints and corrective action plans with guidance and interpretation.
• Ensures that provider information is updated annually in appropriate database as determined by central office or regional needs.
• Contact enrolled medical and dental THS providers at a minimal annually, to provide technical assistance with an on-site visit that promotes education, outreach and training.
• Identifies provider training needs and offers appropriate training and educational sessions.
• Maintains Vision & Hearing Trainer Certification and conducts provider trainings as requested.
• Knowledge of Vision & Hearing Policies and regulations. Knowledge of Medicaid policies and regulations and program impact.
• Participates in community activities for the promotion and marketing of THS program.
• Contacts potential medical, dental or CPW providers to explain the THS program and works collaboratively with public health partners to develop strategies to increase number of THS providers and retain current providers.
• Attends and participates in regional and statewide THS meetings for program planning.
• Actively participate and serve in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation.
• Maintains an acceptable driving record, a valid class C Texas driver's license.
• Working knowledge of Human Resources, Information Technology, Administrative Policy and Program Policy.
• Completes all Public Health Emergency Response, COOP, and other state mandated trainings.
• Reports time, labor and travel information in a timely manner.
• Other duties as assigned by program manager including special assignments.

Benefits

• DSHS offers insurance coverage and other benefits available through the State of Texas Group Benefits Plan administered by the Employee Retirement System of Texas (ERS).

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level