Program Policy Medicaid Modernization Lead

TX-HHSC-DSHS-DFPS•Austin, TX

3d•$4,523 - $7,254•Onsite

About The Position

The Program Policy team within the Medicaid and CHIP Services (MCS) Office of Policy is seeking a Program Specialist V who will serve as the Program Policy Medicaid modernization lead. Medicaid modernization is an agency-wide project to streamline and update the highly complex network of interconnected systems that support Texas’ Medicaid delivery system. This position will have specialized knowledge in medical billing and coding and serve as the managed care policy liaison between Program Policy and MCS Operations, HHSC Information Technology, and technology vendors. Additionally, this position will serve as the lead analyst on managed care policy questions and projects related to medical benefits and billing processes. This position performs advanced consultative and technical work related to the planning, developing, implementing, and maintaining new technology contracts, and amending existing technology contracts to implement Medicaid modernization efforts. This includes a range of responsibilities including: Coordinates and collaborates with internal and external stakeholders to create and update policies, procedures, contract requirements, administrative rules, business rules, and communications to external stakeholders and contractors. Develops project timelines for assigned projects, monitors and reports on progress, and updates timelines as necessary. Coordinates and collaborates with the internal and external stakeholders to schedule standing meetings, respond to policy inquiries, draft reports, update content in public documents and websites, and manage shared mailboxes. Assists in researching managed care organizations’ compliance with program policy contractual requirements. Participates in and helps to facilitate meetings with stakeholders, including managed care organizations, provider associations, people receiving services, and subject matter experts. This position reports to a Manager for Program Policy in the Medicaid and CHIP Services Division. This position works under limited supervision, with considerable latitude for the use of initiative and independent judgment.

Requirements

Knowledge of State and federal Medicaid and CHIP laws and regulations
Knowledge of Complex national medical billing and coding requirements, CMS requirements, Medicare and Medicaid billing processes
Knowledge of CPT, HCPCS, NCCI, and ICD medical billing and coding systems
Knowledge of Government organization and administration
Knowledge of Principles of health and human services policy and planning
Knowledge of State of Texas legislative processes
Skills in Medical billing and coding
Skills in Analyzing, evaluating, and interpreting complex federal and state legislation, program, policy, and operations issues
Skills in Project management policy analysis, and performing policy research
Skills in Synthesizing, analyzing, and evaluating highly complicated and technical information
Skills in Translating policy and technical information into easily understandable and concise documents and oral presentations.
Skills in Developing creative and workable solutions to complex problems and policy issues
Skills in Facilitating stakeholder and different workgroup meetings
Ability to Develop, amend, and interpret program policies, rules and contract requirements related to Medicaid and CHIP Services
Ability to Develop and provide information to support lean business cases for information technology projects
Ability to Research, gather, assemble, correlate, and analyze data to devise solutions based on the information available
Ability to Work with a team under pressure, negotiate among multiple parties, and resolve conflicts
Ability to Exercise judgment and work independently with minimum supervision
Ability to Work cooperatively as a team member in a fast-paced, deadline-oriented environment
Ability to Establish and maintain effective working relationships with various levels of personnel in government entities
Ability to Utilize Microsoft Office Suite applications such as Outlook, Teams, Word, PowerPoint, Planner and Excel
Ability to Communicate effectively orally and in writing, including the ability to adjust communications to fit the intended audience
Ability to Work with diverse groups of people, including stakeholders, that have a variety of opinions
High school diploma and at least five years of full-time work experience in a health and human services field; OR Bachelor’s degree from an accredited four-year college or university and at least one year of full-time work experience in a health and human services field; or Master’s degree from an accredited college or university in public health, public administration, public affairs, social work, or closely related field.
Candidate must also have medical billing and coding education and/or experience.

Nice To Haves

Work experience in developing and analyzing Medicaid policies.
Medical Billing Certification.

Responsibilities

Collaborates with other areas of MCS and HHSC to plan, develop, implement, monitor, interpret and evaluate Medicaid programs, policies, MCO contract requirements, business rules, administrative rules, waivers, and state plan. Evaluates MCO compliance with program policies and procedures, contract requirements, statutes, and rules and takes corrective action if needed. (25%)
Plans, monitors, and evaluates MCS implementation of state legislation, federal legislation, and federal rules. Analyzes state legislation, federal legislation, and federal rules to evaluate its impact to MCS and stakeholders, including MCOs, service providers, and members. (25%)
Establishes, facilitates, and participates in relevant workgroups and committees, including inter-agency workgroups and committees. Coordinates and provides requested training to internal staff and external entities. (20%)
Prepares high quality written documents such as project updates, reports, PowerPoint presentations, communications to stakeholders and contractors, executive memos, policy and project summaries, legislative reports, administrative rules, waivers, and state plan amendments. (20%)
Other duties as assigned. (10%)