Texas Health and Human Services · 1 week ago
Specialty Health Quality Assurance Specialist
Austin, TX
Full-time
Hybrid
Entry, Mid Level
$4,263.16/mo - $5,521.16/mo
2+ years expTexas Health and Human Services Commission (HHSC) is committed to creating a positive impact in the lives of fellow Texans. The Quality Assurance Specialist will perform advanced quality assurance activities across Specialty Health program operations, focusing on improving call center performance, eligibility processing, and provider enrollment.
Health Care
No H1B
Responsibilities
Plans, coordinates, and executes quality monitoring plans for call center operations, eligibility processing, provider enrollment, and reimbursement functions
Conduct quality reviews of SH program functions, including call evaluation, application and redetermination processing, and claims and payment activities on a regular schedule
Reviews, refines, and optimizes quality monitoring procedures and tools to ensure accuracy and alignment with program goals
Performs data collection, analysis, and interpretation from quality reviews and operational reports
Prepares detailed, actionable reports and dashboards that identify patterns, risks, and performance gaps
Summarizes and communicates quality findings to SH leadership and program teams
Assist team members with quality reviews and consolidate results into clear summaries and recommendations
Collaborates with SH program areas to establish meaningful quality improvement metrics that reflect program expectations and client needs
Plans, initiates, and manages improvement initiatives resulting from monitoring findings, patterns, and data trends
Conducts root-cause analyses and supports development of improvement plans
Oversee the full lifecycle of assigned quality assurance projects, including planning, execution, monitoring, and reporting
Maintains and updates project documentation such as project plans, process maps, results summaries, and gap analyses
Provides clear recommendations to leadership and program areas on opportunities for improvement and areas needing further review
Tracks outcomes of improvement activities to ensure intended results are achieved
Serves as a point of contact and subject-matter resource for quality assurance and improvement activities
Works with programs to understand operational processes and areas where additional quality review or monitoring may be needed
Develops and updates documentation, guidance materials, checklists, review tools, and training resources related to quality standards and monitoring expectations
Communicates review findings, improvement needs, and quality expectations in a clear and accessible manner
Provides technical assistance to staff and leadership to support implementation of improvement recommendations
Supports consistency across SH program areas by clarifying expectations and sharing quality insights with internal teams
Other Duties as Assigned
May include participating in disaster response or recovery operations, supporting continuity of operations efforts, and assisting the agency in emergent needs consistent with the responsibilities of this position
Qualification
Required
2 or more years experience in conducting quality assurance, auditing, or compliance activities in a healthcare or public service setting
Experience in developing and delivering data reports or dashboards using data visualization software (example PowerBI, Smartsheet, etc.)
Knowledge of local, state, and federal laws related to the program areas and public administration
Knowledge of quality assurance measurement methods
Knowledge of statistical sampling and analysis processes
Knowledge of research and problem-solving techniques
Knowledge of quality assurance and improvement activities
Knowledge of administration techniques, training, planning and implementation
Skill in identifying measures or indicators of program performance
Skill in measuring program performance and identifying opportunities for improvement
Skill in pursuing quality improvement initiatives
Skill in the use of a computer and applicable software
Skill in using computer systems, electronic mail systems, programs of the Microsoft 365 suite or equivalent
Skill in communicating knowledge effectively to a variety of audiences, both verbally and in writing
Skill in developing and presenting presentations to the public and other agencies
Ability to organize and manage multiple tasks with competing deadlines
Ability to interpret state and federal laws, regulations, rules, and policies related to the programs
Ability to identify problems, analyze all relevant information, identify possible solutions and select an appropriate solution
Ability to serve as an expert resource during workgroups or team meetings
Ability to analyze data and produce reports
Ability to identify, carry out, and report progress on critical quality measurements
Ability to engage in crucial conversations to manage and resolve work-related issues
Ability to communicate and work effectively with individuals and groups and to share knowledge with co-workers
Ability to build and maintain professional relationships with both internal and external stakeholders
Ability to develop and maintain professional relationships with both internal and external stakeholders
Ability to serve as a lead worker providing guidance to others
Preferred
Accredited quality certification (Certified Quality Inspector (CQI), Lean Six Sigma, or similar) or project management certification (Agile, PMP, or similar)
Benefits
100% paid employee health insurance for full-time eligible employees
Defined benefit pension plan
Generous time off benefits
Numerous opportunities for career advancement
Company
Texas Health and Human Services
Texas Health and Human Services is an agency that focuses on improving health, safety and well-being.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Dr. Napoleon Broughton
Chief Executive Officer: Life Enhancement Solutions
John F. Palermo
CTO Strategic Analyst VI
Recent News
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