THSteps Provider Relations Representative

Job Description :

Under the direct supervision of Program Supervisor and overall direction of the Program Manager, performs moderately complex (journey-level) consultative services and technical assistance to program staff, community organizations and Texas Health Steps (THS) Providers.

Serves as a THS Provider Representative and liaison to provide technical assistance on THS specifics and requirements. Duties include, performing an array of technical, trainings, research, planning, and program assessment related to the Texas Health Steps (THS) program.

Collaborates, communicates and assists with Managed Care Organizations (MCO’s) and Texas Medicaid (TMHP) for providers regarding billing issues.

Performs consultative visits to Providers and private agencies to discuss program issues, markets the program and conducts THS Workshops.

Performs comprehensive reviews of THS literature, statutes, rules, and / or policies and prepares reports as needed. May provide guidance to other THS Provider Representatives.

Works collaboratively with public health staff in the event of a regional or state disaster. Works under general supervision with limited latitude for the use of initiative and independent judgement.

Maintains confidentiality. Essential Job Functions :

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.

l. Essential Job Function (45%) : Provider Support

Description : 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.

ll. Essential Job Function (25%) : Program Support

Description : 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.

lll. Essential Job Function (15%) : Trainings & Presentations

Description : 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.

lV. Essential Job Function (10%) : Community & Outreach Activities.

Description : 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.

V. Essential Job Function : (5%) Adherence to Policy and Other Duties as Assigned.

Description : 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. Knowledge Skills Abilities :

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

Ability to work independently with minimum supervision