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.

BUSINESS CONFIGURATION & EPIC GOVERNANCE

• Lead the strategy, governance, execution, and quality oversight of Epic business configuration and related health plan systems supporting benefits, provider contracts, reimbursement methodologies, fee schedules, authorization requirements, claims adjudication, and provider setup.

• Establish governance standards, configuration intake processes, approval workflows, controls, documentation requirements, decision rights, escalation pathways, and performance measures.

• Ensure system configuration requests and changes are appropriately evaluated, prioritized, tested, approved, and implemented in alignment with business, contractual, regulatory, and operational requirements.

PAYMENT OPERATIONS & CLAIMS SUPPORT

• Provide leadership and oversight for payment operations and claims payment support, ensuring accurate, timely, and compliant provider payments.

• Oversee payment issue resolution, payment holds, adjustments, reimbursement validation, high-impact claims review, and coordination with Finance and Accounts Payable.

• Monitor payment inventories, aging, service levels, claims pends, production issues, and emerging trends while establishing escalation and mitigation plans for high-risk issues.

CENTRALIZED TESTING & OPERATIONAL READINESS

• Establish and lead a centralized business testing function encompassing test planning, test execution, user acceptance testing, regression testing, defect management, retesting, and go-live readiness.

• Develop consistent testing standards for Epic upgrades, regulatory changes, new products and benefits, reimbursement changes, provider contract updates, authorization workflows, vendor changes, and major operational initiatives.

• Ensure testing validates end-to-end business processes and downstream impacts across configuration, claims, payments, authorizations, provider operations, reporting, and member experience.

REGULATORY COMPLIANCE, RISK & PERFORMANCE

• Ensure configuration, payment operations, testing, and Epic governance processes support regulatory, contractual, compliance, and audit requirements.

• Maintain effective controls around configuration approvals, payment changes, testing evidence, defect resolution, implementation decisions, production validation, and documentation.

• Develop and present executive-level reporting on operational performance, configuration accuracy, payment trends, testing readiness, defects, root causes, corrective actions, and emerging risks.

PEOPLE LEADERSHIP & CROSS-FUNCTIONAL PARTNERSHIPS

• Build, lead, and develop high-performing teams with clear expectations, measurable outcomes, succession planning, and a culture of accountability and continuous improvement.

• Partner across Claims, Contracting, Provider Data Management, Finance, Utilization Management, Medical Policy, Compliance, Information Systems, Epic technical teams, and operational leadership to drive effective execution and resolve complex dependencies.

• Serve as a senior advisor to executive leadership on Epic governance, configuration risk, payment performance, testing readiness, resource needs, and implementation priorities.

• Represent the department in governance forums, steering committees, implementation meetings, audit discussions, vendor reviews, Epic upgrades, and executive operational updates.

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

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

• 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.

• Lean Six Sigma certification

• Project Management Professional (PMP)

• Healthcare Compliance certification

• Epic certification

• Other related professional certifications