Sr Business Process Mgmt Spec

About Us
Job Description

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
  
  

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Skills / Requirements

JOB SUMMARY

The Sr. BPM Process Mgmt. Specialists role will devise and design business process requirements for all IT-related business, financial, and operations systems critical to core organizational functions. This includes researching and analyzing data in support of business functions, process knowledge, and systems requirements. The Sr. BPM Process Mgmt. Specialist's is also responsible for proactively generating and compiling reports with recommended improvements to / or new requirements for business processes and operational procedures. This individual will apply proven communication, analytical, and problem-solving skills to help maximize the benefit of IT system investments.

JOB SPECIFICATIONS

Research, review, and analyze the effectiveness and efficiency of existing processes and develop strategies for enhancing or further leveraging these processes. Prototype new procedures for the purpose of enhancing business processes, operations, and information process flow.

Lead, oversee and influence others, especially to deliver projects on-time, on-budget, and to achieve/exceed the project goals. Facilitate issue escalations and resolution across the project team, steering committee, and key business stakeholders. Coordinate and partner with the Sr. Manager IS Sys Applications to develop and foster a highly effective team, ensuring that established goals and standards are met, manages daily workload to uphold productivity levels, quality outcomes, performance guarantees, timeliness, and customer satisfaction metrics.

Develop, standardize, and maintain new or improved processes based on findings and analysis. Communicate process changes, enhancements, and modifications to management, peers, staff, and other employees so that issues and solutions are understood. Manage process improvement projects by following an established methodology and by employing project management skills/techniques

Prepare and deliver reports, recommendations, or alternatives for improving processes across the organization.

Liaise with various business groups in the organization to facilitate implementation of new or improved business processes.

Independently analyses and proposes improvements to key business processes for efficiency and improvement

Mentor, provide guidance and/or instruction to junior staff members and business partners

Other duties as assigned.

Qualifications

Education/Specialized Training/Licensure: High School diploma or equivalent required

Formal training in LEAN methodologies (Certified Lean Six Sigma Green Belt or above) required.

Bachelors degree in the field of business administration, computer science, finance, or management information systems preferred.

Work Experience (Years and Area): In lieu of degree, 5 years (minimum) related work experience inclusive of 3 years experience with health insurance, managed care, or other related experience. Individual should have an extensive knowledge of Texas Medicaid and Marketplace products.

STAR PLUS

Management Experience (Years and Area): 1-year supervisory experience preferred.

Software Proficiencies: Visio, MSFT Office Suite (Planner, Project)

Experience with core software applications, including Service Now, Sales Force, Claims, Mural

Other: Experience in Quality Management

Proven experience with business and technical requirements analysis, business process modeling/mapping, methodology development, and data modeling.

Experience overseeing the design, development, and implementation of software and hardware solutions, systems, or products.

Experience with leading or contributing to process improvement projects related to patient safety, quality of care, access to care, or high reliability organization transformation.

Ability to create systematic and manual operations procedures in both technical and user-friendly language.