Case Analyst
About The Position
The Program Specialist V – Case Analyst (CA) is part of the Texas Health and Human Services (HHS) Office of Inspector General (OIG) Chief Counsel Division. The CA performs highly advanced (senior-level) consultative and technical work. Under the guidance of the Director of Financial Analysis and Case Management, the CA engages in assisting with the enforcement of assessed final debt amounts, and any associated collection activities. The duties of this position involve reviewing, researching, analyzing, and evaluating case results, investigative findings and payments related to complex cases involving health care provider fraud, waste and/or abuse in the Medicaid system as well as other Texas Health and Human Service programs. Responsibilities include making recommendations and assisting in processing contract cancellations, exclusions and terminations. The CA interprets policies, procedures, rules, regulations, and standards related to Texas health and human services programs and must ensure compliance with federal and state laws and regulations. The CA works under general supervision of the Director of Financial Analysis and Case Management or his/her designee. The CA works under limited supervision, with considerable latitude for the use of initiative and independent judgment.
Requirements
- Knowledge of state and federal laws related to the public health care programs such as Medicaid and Medicare.
- Knowledge of collection processes.
- Skill in use of personal computer, computer software, includes spreadsheet, database, and word processing applications.
- Skill in communicating effectively in writing and orally.
- Ability to research facts and law from a variety of databases.
- Ability to review legal and medical files and distill salient information.
- Ability to interpret policies, procedures, rules, regulations, and standards.
- Ability to establish and maintain collegial and collaborative working relationships with co-workers, agency staff, and management to achieve common goals.
- Ability to manage work time efficiently to complete assignments within in a timely manner with limited supervision.
- Graduation from a four-year college or university, preferably with major course work in business or health care administration.
- Experience in a field related to business operations involving heath care or law may be substituted for the education requirement on a year-for-year basis.
- Experience using Microsoft applications – specifically Excel.
Nice To Haves
- Knowledge of Texas state government structure and functioning.
Responsibilities
- Assists with the enforcement of assessed final debt amounts, and any associated collection activities 40%
- Conducts research pertaining to case results, investigative findings, and payments to make determinations and recommendations concerning contract cancellations, exclusions, terminations and or impacted program areas. 40%
- Handles all case closing processes to include scanning and uploading relevant documents into the case management system and case library and closing completed cases. 10%
- Prepares monthly and annual reports with supporting tables and documentation for use by internal and external stakeholders. 5%
- Performs other duties as assigned. Keeps manager informed as required or as necessary. 5%
Benefits
- 100% paid employee health insurance for full-time eligible employees
- a defined benefit pension plan
- generous time off benefits
- numerous opportunities for career advancement
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What This Job Offers
Job Type
Full-time
Career Level
Senior
