Director of Business Configuration, Payment Operations & Centralized Testing

At Texas Children’s, our HEART values — Humility, Excellence, Accountability, Respect, and Trust — guide how we lead, collaborate, and serve our patients, members, providers, and one another.

Texas Children’s Health Plan is seeking an experienced operational leader to provide strategic oversight of business configuration, payment operations, centralized testing, and Epic system governance. This role will establish and maintain the governance, controls, and operational framework needed to ensure health plan systems and processes are accurate, compliant, efficient, and aligned with business and regulatory requirements.

The leader will oversee complex, enterprise-wide functions spanning Epic business configuration, provider payment operations, business testing and validation, operational readiness, and performance governance. Working closely with operational, financial, compliance, contracting, and technology partners, this individual will translate business requirements into effective system configuration and sustainable operational processes.

EDUCATION

Required

- Bachelor’s degree in Business Administration, Healthcare Administration, Information Systems, Finance, Public Health, or a related field

Preferred

- Master’s degree in Business Administration, Healthcare Administration, Public Health, Information Systems, Finance, or a related field

EXPERIENCE

Required

- 10+ years of experience in managed care operations, health plan administration, claims or payment operations, business configuration, system implementation, centralized testing, provider reimbursement, or related payer operations.
- 5+ years of formal leadership experience managing teams, managers, analysts, operational functions, testing or configuration teams, or cross-functional implementation resources.

Preferred

- Experience with Epic Tapestry and/or health plan system configuration and governance.
- Experience supporting Medicaid managed care programs , including CHIP, STAR, STAR Kids, and/or LTSS.
- Experience with provider reimbursement, claims adjudication, authorization workflows, encounter data, risk adjustment, and business testing .
- Experience supporting regulatory readiness, state agency reviews, audits, or other payer compliance activities .

PREFERRED LICENSES & CERTIFICATIONS

- Lean Six Sigma certification
- Project Management Professional (PMP)
- Healthcare Compliance certification
- Epic certification
- Other related professional certifications