Health Coordinator OR Health Coordinator Senior

Location : 1900 Aldrich Street

Austin Texas 78723

United States

Health Coordinator OR Health Coordinator Senior

Requisition ID : req1303

Employment Type :

Unclassified Regular Full-Time (URF)

Division : Health Operations

Compensation :

62113.00 - 92237.00 Annual Salary

Location : 1900 Aldrich Street

Job Closing : 10 / 28 / 2025

WHO WE ARE :

With the Health Division youll be joining a passionate team of self-motivated change agents united by our mission : driving to design the delivery of high-quality healthcare for nearly three-quarters of a million active and retired Texas public educators. The healthcare industry is complex and were a team of problem-solvers who are up for the challenge. With a focus on innovation and collaboration to catalyze the market we spend more than $4 billion annually on healthcare to make a difference in our members lives. With a career at TRS youll be empowered through a culture of continuous learning front-line decision making coaching and mentorship to shape the future of our work while transforming healthcare delivery for 1 in 41 Texans.

The Health Coordinator is responsible for providing direct member support. This includes but is not limited to processing member requests for enrollments terminations eligibility checks and various healthcare documents. The incumbent will conduct complex group health benefit research and analysis assist with administering health and insurance programs and may assist with coordinating vendor and contract administration operations. This position will proactively work with the Health Benefits team Health staff and agency employees while maintaining a customer-centric approach with a focus on process improvement and delivering exceptional service.

The Health Coordinator Senior provides complex research and analysis and group health benefit consultation. The incumbent will conduct complex TRS-Care Rules and Laws review and interpretation group health benefit research and analysis assist with vendor and contract administration and provide training and technical assistance. This position proactively works with Health Operations team Health Staff TRS members Health Legal Counsel and the Chief Health Care Officer while maintaining a customer-centric approach with a focus on delivering exceptional service.

This vacancy will be filled at one of two levels - Health Coordinator or Health Coordinator Senior. Selected applicant will be offered the position that most closely matches their education and experience.

Salary Range :

Health Coordinator : $62113.00-$77640.00 Annually

Health Coordinator Senior : $73790.00 - $92237.00 Annually

WHAT YOU WILL DO

Research and Analysis (Health Coordinator Senior)

Researches analyzes resolves and responds to complex and / or time-consuming member inquiries regarding group health benefits and related programs rules policies procedures and systems.

Reviews documentation relating to benefits to ensure conformity to agency and legal requirements.

Coordinates and communicates both orally and in writing with agency staff school districts and members their families and their representatives to ensure appropriate resolution of benefit issues.

Conducts appeal reviews regarding insurance eligibility and enrollment issues and oversees vendor adjudication of benefit determination appeals including those involving a determination of medical necessity.

Coordinates with vendors regarding claim appeals received from medical providers.

Researches analyzes and evaluates current program guidelines related to Direct Bill In-House Collections and all Member Level Accounting. Serves as a Subject Matter Expert to determine benefits and eligibility.

Researches analyzes and evaluates current program guidelines related to specific Health Benefit eligibility related to Medicare ESRD INCAP Surviving Spouse / Dependents and Disability.

Serves as a Subject Matter Expert to determine benefits and eligibility.

Prepares report as necessary to support tracking trends discrepancies related to Medicare ESRD INCAP Surviving Spouse / Dependents and Disability.

Responds to written requests and complaints received from retirees and active school district employees regarding their health insurance coverage.

Researches and analyzes other state group health programs for comparison with TRS health plans claims data reports from vendors and other TRS health plan data.

Process healthcare documents in the TRS-Care queues and TRSActiveCare queues.

Supports implementation and maintenance of enrollment workflows in the HILOB and TRUST-CRM systems.

Analyzes current operational processes and makes improvement recommendations based on operational strategies.

Member Service Support

Processes healthcare documents related to POAs Enrollments Eligibility Deceased and Survivor Benefits Divorce INCAP ESRD COBRA and Disability received from the healthcare vendors and in the TRS-Care and TRS-ActiveCare queues.

Ensures completion of TRS-Care benefit related correspondence materials including TRS-Care quick reference guides enrollment guide and benefit information booklets.

Supports implementation and maintenance of enrollment workflows in the HILOB and TRUST-CRM systems.

Researches analyzes resolves and responds to complex and / or time-consuming member inquiries regarding group health benefits and related programs rules policies procedures and systems.

Reviews documentation relating to benefits to ensure conformity to agency and legal requirements.

Coordinates and communicates both orally and in writing with agency staff school districts and members their families and their representatives to ensure appropriate resolution of benefit issues.

Analyzes current operational processes and makes improvement recommendations based on operational strategies.

Assists with escalated calls from TRS-Care and TRS-ActiveCare plan participants as necessary.

May respond to daily customer service calls through the TRS IVR regardingTRS-Care / ActiveCare healthcare benefits.

Actively responds to daily customer service calls that come through the TRS IVR regarding associated TRS-Care and TRS-ActiveCare healthcare benefits. (Senior)

May assist the review of member-facing education and communication related materials and department intranet website updates to assure that materials are appropriate to the member audience.

Assists with escalated calls from TRS-Care and TRS-ActiveCare plan participants as necessary. (Senior)

May assist to resolve member and entities appeals grievances and escalated concerns. Responds by telephone or written correspondence to inquiries from customers internal / external regarding TRS Care / ActiveCare requirements and associated laws rules policies procedures and systems.

May reconcile and process Member Level Accounting data related to direct bill collections premiums and / or annuity adjustments.

May conduct reviews regarding insurance eligibility and enrollment issues and oversees vendor adjudication of benefit determination appeals including those involving determination of medical necessity.

May coordinate with vendors regarding claim appeals received from medical providers.

May research and analyze other state group health programs for comparison with TRS health plans claims data reports from vendors and other TRS health plan data.

Participates in the review of member-facing education and communication related materials and department intranet website updates to assure that materials are appropriate to the member audience. (Senior)

Ensures completion of TRS-Care benefit related correspondence materials including TRS-Care quick reference guides enrollment guide and benefit information booklets. (Senior)

Program Administration

Develops and implements improvement and enhancements including plan provisions / exclusions based on medical necessity or experimental / investigational medical services.

Researches analyzes and evaluates current program plans practices policies procedures guidelines processes systems and forms.

Generates accurate reporting to support operational and regulatory needs and ensure data integrity.

Supports preparation of ad hoc and periodic reports for TRS management Board of Trustees Texas Department of Insurance and Legislative Budget Board.

Serves as a technical resource regarding group health benefit programs rules policies procedures processes and systems including identifying and developing new and enhanced internal processes.

May assist with identifying test cases and be involved in testing to ensure changes are implemented accurately.

May conduct training for TRS health and insurance benefits staff and other agency staff.

May assist in analyzing the impact of new and proposed legislation on group health benefit programs and operations and in developing recommendations for future legislation.

Leads or participates on special projects task forces and committees. (Senior)

Prepares ad hoc and periodic reports for TRS management Board of Trustees Texas Department of Insurance and Legislative Budget Board. (Senior)

Generates accurate reporting to support operational and regulatory needs. (Senior)

Vendor and Contract Administration

Coordinates and consults with vendors and evaluates vendor proposals for changes in processes additions to covered drugs and other plan changes makes recommendations for acceptance or modification of proposals.

Coordinates program changes with vendors and TRS staff.

Monitors and reconciles enrollment files from external partners.

Assists with healthcare implementation projects and initiatives.

Assists with healthcare implementation projects and initiatives and may lead sub-team projects within an implementation plan. (Senior)

May serve as Health contact for medical and pharmacy vendors.

May participate in the vendor procurement process including assisting with developing contract specifications and requests for proposal (RFP) selecting vendors and drafting or modifying new and re-issued group health benefit contracts. (Senior)

Performs related work as assigned.

WHAT YOU WILL BRING

Required Education

Bachelors degree from an accredited college or university in accounting finance mathematics business health care administration or similarly related field.

High school graduation or equivalent and additional full-time experience in health care health insurance administration benefits administration claims processing or similarly related experience may substitute on an equivalent year-for-year basis.

Required Experience

Four (4) years of full-time directly related progressively responsible experience in health care health insurance administration benefits administration claims processing or similarly related experience.

Six (6) years of full-time directly related progressively responsible experience in health insurance administration claims processing benefit processing or a customer service-related position involving interpreting applying and communicating complex laws regulations and policies. (Senior)

A masters degree or doctoral degree in a directly related field may be substituted on an equivalent year-for-year basis.

Preferred Qualifications

Bachelors degree from an accredited college or university.

Masters degree from an accredited college or university. (Senior)

Recent experience in the group health insurance industry.

Experience planning and facilitating meetings and or formally presenting in a group setting.

Experience in process improvement methodologies.

Bilingual in English and Spanish.

Knowledge of :

Health benefit eligibility criteria enrollment processing Medicare and coordination of benefits.

Health insurance administration products and terminology.

Health insurance administration plan funding and asset management. (Senior)

TRS laws regulations policies procedures and information systems.

Customer relationship management systems and database management.

Principles practices and techniques associated with program and project management. (Senior)

Claim administration utilization management employee benefits and general underwriting practices and principles. (Senior)

The operations and benefits of Medicare Medicaid TRICARE and other universal government programs. (Senior)

Skills in :

Reviewing documentation and in interpreting and applying complex laws regulations rules and policies and in making decisions based on sound judgment.

Project management and in planning organizing and prioritizing work assignments to manage a high-volume workload in a fast-paced and changing environment and in completing detailed work with a high degree of accuracy.

Managing projects including planning organizing and prioritizing work assignments to manage a high-volume workload in a fast-paced and changing environment and in completing detailed work with a high degree of accuracy. (Senior)

Analyzing problems and devising effective solutions through critical analysis.

Effective written and verbal communication including preparing and delivering complex correspondence reports and presentations.

Effective written and verbal communications including telephone communications and drafting and delivering complex correspondence reports and presentations. (Senior)

Using a computer in a Windows environment with word processing spreadsheet and other business software.

Utilizing a personal computer and various business software programs including Microsoft Word Excel and Outlook. (Senior)

Providing quality customer service.

Entering data accurately and applying attention to detail to all work through organizational skills.

Ability to :

Meet frequent and multiple deadlines manage conflicting priorities and demands and adapt to changes in schedules and assignments. (Senior)

Communicate adverse information to members regarding their plan benefits while educating about the value of the plan.

Establish and maintain harmonious working relationships with co-workers agency staff vendors contractors and other external contacts.

Work effectively in a professional team environment.

Learn and adapt to new technologies quickly.

Learn and take on new challenges.

Military Occupational Specialty (MOS) Codes :

Veterans Reservists or Guardsmen with experience in the Military Occupational Specialty ( ) along with the minimum qualifications listed above may meet the minimum requirements and are highly encouraged to apply. Please contact Talent Acquisition at with questions or for additional information.

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Required Experience :

IC

Key Skills

EMR Systems,Employee Relations,Typing,Patient Care,Clerical Experience,HIPAA,Computer Skills,EMT Experience,Medical Terminology,Transcription,Epic,Phone Etiquette

Experience : years

Vacancy : 1

Yearly Salary Salary : 73790 - 92237