Texas Medicaid Operations Specialist - Hybrid Texas

Medicaid; Richardson (TX); Hybrid; USD 56,000 - 124,000; Full time

Job summary

HCSC in Richardson, TX is seeking a qualified professional to lead operational services and program implementation across Texas Medicaid functions including UM, CM, reporting, and enrollment. You will resolve complex questions and partner with internal teams to ensure state compliance, using data to drive performance improvements.

The role demands a business background with health insurance operations experience, strong communication, and project management skills.

Qualifications

• Bachelor's degree in Business with 4 years’ experience OR 8 years in health insurance operations.
• Experience in project development, implementation and execution.
• Experience interfacing with internal clients and operations personnel.
• Strong verbal and written communication and ability to represent Medicaid department.
• Experience managing multiple projects and coordinating priorities.
• Strong analytical, organizational, and interpersonal skills.
• Experience with Texas Medicaid UM/CM operations preferred.
• Knowledge of Texas Medicaid UMCM and UMCC requirements.

Responsibilities

• Provide operational services, assistance, and program implementation for day-to-day Medicaid functions (UM, CM, reporting, compliance, billing, claims, enrollment, customer service).
• Resolve complex and escalated internal or external operational questions.
• Collaborate with other areas to develop, test, and implement policies, reporting, and system changes to meet state requirements.
• Focus on Texas Medicaid managed care operations, interpreting UMCM/UMCC requirements and monitoring performance to identify gaps and support compliance.

Skills

Project management

Client interfacing

Verbal & written communication

Multi-project management

Leadership

Analytical skills

Organizational skills

Texas Medicaid UM/CM experience

Education

Bachelor Degree in Business

Tools

Power BI

Microsoft Excel (Advanced)

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

This position is responsible for providing operational services, assistance, and program implementation and coordination for one or more of the day-to-day Medicaid operational functions, including Utilization Management (UM), Care Management (CM), reporting, compliance, billing, claims, enrollment, and customer service. This resource is responsible for resolving complex and/or escalated internal or external operational questions. Additionally, this position works with other areas of the organization on the development, testing, and implementation of program policies, business processes, reporting solutions, and system changes to ensure the state requirements of the plan are met. The role will have a particular focus on Texas Medicaid managed care operations, including interpreting and supporting requirements outlined in the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM) and applicable managed care contracts, while using data and reporting to monitor operational performance, identify gaps, and support compliance.

Required Job Qualifications:

• Bachelor Degree in Business with 4 years’ experience OR 8 years of experience working in health insurance operations
• Experience in project development, implementation and execution skills
• Experience interfacing with internal clients, operations personnel
• Verbal and written communication skills and ability to represent Medicaid department at committee meetings
• Experience with interacting effectively with all levels of internal and external customers
• Experience managing multiple projects effectively
• Interpersonal, organizational and analytical skills
• Organizational and leadership skills

Preferred Job Requirements:

• Experience with managing contract provisions
• Experience in Project Management
• Direct experience supporting Texas Medicaid managed care operations, preferably within a Medicaid Managed Care Organization (MCO), healthcare services organization, delegated entity, or vendor supporting a Texas Medicaid population.
• Working knowledge of the Texas Medicaid and CHIP Uniform Managed Care Manual (UMCM) and the Uniform Managed Care Contract(UMCC) requirements to ensure that and the and experience interpreting or applying UMCM requirements to operational processes, reporting, deliverables and , or compliance activities are compliant.
• Hands-on experience with Texas Medicaid Utilization Management (UM) and/or Care Management (CM) operations.
• Experience working with or interpreting Texas Medicaid managed care contract requirements, including the relationship between contract requirements, UMCM guidance, and operational execution.
• Experience monitoring operational performance or compliance, identifying gaps, validating deliverables/data, and coordinating corrective actions or operational improvements.
• Strong reporting and data-analysis skills, including advanced Microsoft Excel; Power BI/dashboard development or reporting experience strongly preferred.
• Experience with managing contract provisions
• Experience in Project Management
• Ability to analyze complex Medicaid operational requirements and translate them into clear business requirements, processes, reporting, and actionable recommendations.
• Location: Richardson, TX or Austin, TX offices
• Schedule: This is a Flex (Hybrid) role: 3 days in office; 2 days remote.
• Sponsorship: Sponsorship is not available

Compensation: $55,900.00 - $123,500.00

Exact compensation may vary based on skills, experience, and location

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards