A&M Program Specialist 1

Texas Health & Human Services Commission•Orange, TX

37d

About The Position

Performs complex SNAP, CHIP, CHIP Perinatal and Medicaid case administrative reviews and determines eligibility for retroactive coverage. Work involves resolving complaints, performing routine consultative services, providing technical assistance, facilitating extensive coordination, and problem solving related to Appeals for SNAP, CHIP and Medicaid cases. Evaluates adherence to contracts, policies, procedures, guidelines, and implements agency program policies to ensure compliance with Health and Human Services (HHS) program requirements. Work involves assisting with the identification of recurring issues within the agencies or programs, and notifying management with developed recommendations, options, and solutions to improve or address areas of concern. May supervise the work of others. Works under moderate supervision with limited latitude for the use of initiative and independent judgment.

Requirements

Knowledge of Eligibility programs, requirements, and policies.
Knowledge of Health Insurance Portability Accountability Act (HIPPA) and Tax Sensitive information regulations.
Knowledge of SNAP and Medicaid/ Children's Health Insurance Program (CHIP) and CHIP Perinatal program policy.
Knowledge of SNAP, Medicaid and CHIP appeals process.
Knowledge of customer relations principles and practices.
Knowledge of interviewing techniques to obtain highly personal information, make inquiries, and resolve conflicting statements.
Ability to interpret, analyze, and evaluate complex program policy and rules and regulations and make accurate assessments.
Skill in the use of computer and programs such as Microsoft Outlook, Microsoft Excel, Word, and Power Point.
Skill in the use of TIERS, State Portal, Maximus Enrollment Broker, and other HHS automated systems.
Skill in analyzing, evaluating, and resolving highly complex program and policy issues.
Skill in interpreting and applying agency, state, and federal rules, regulations, policies, and procedures.
Skill in the use of automated data systems.
Skill in providing customer service.
Ability to read, understand, and apply a variety of interrelated instructions, such as those found in guidelines, regulations, and policies.
Ability to interpret, analyze, and evaluate complex program policy and rules and regulations and make accurate assessments.
Ability to interview clients or authorized representatives to gather information to determine eligibility for benefits.
Ability to obtain, verify, and calculate income and resources to determine client financial eligibility.
Experience documenting case records using automated equipment to form a record for each client.
Ability to explain program benefits or requirements to clients.
Manages assigned projects.
Ability to communicate on a complex level with others effectively both verbally and in writing to provide, exchange, verify information, answer inquiries, address issues, and respond to inquiries or complaints.
Ability to gather, assemble, correlate, analyze facts, identify problems, evaluates alternatives, and implement effective solutions to problems.
Ability to effectively organize, prioritize, write, proofread, and prepare concise reports.
Ability to identify problems, evaluate alternatives.
Assist in interpreting policy, training new workers, completing unit reports, responding to client complaints, and acting in the supervisor's absence.
Ability to work independently and make independent judgments with limited supervision.
Ability to establish and maintain effective working relationships with all levels of staff, internal, and external partners.
Ability to work with people under pressure, negotiate among multiple parties, and resolve conflicts.
Ability to handle multiple tasks/projects requiring flexibility to meet tight deadlines.
Ability to establish priorities according to relative importance, set goals, and manage time efficiently.
Ability to train others.
High School Diploma or GED equivalent is required.
Two years' relevant customer service experience with public contact required which can include retail, call center, clerical, hospitality, banking, receptionist, or similar customer service experience.
A minimum of three (3) years' experience as a Texas Works Advisor (TWA) is Required.
Required experience in presenting relevant information concerning program policies and procedures to fellow workers, colleagues, clients, and public in a clear and concise manner.

Nice To Haves

Sixty (60) semesters from an accredited college or university is preferred.
Experience in reading and interpreting CHIP/CHIP-P policy and MEPD policy and procedures is preferred.
Required experience in evaluating case records in relation to agency standards for quality and timeliness.
Experience in the Appeal/CHIP RFR process and procedures is preferred.
Experience in interviewing techniques to obtain highly personal information, making inquiries, and resolving conflicting statements.
Experience providing mentoring support and assistance to staff is preferred.

Responsibilities

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
Researches, analyzes, interprets and applies complex policies and procedures for SNAP, Medicaid and Children's Health Insurance Program (CHIP) when applicants or clients disagree with an adverse action regarding eligibility or when a client requests Retroactive coverage.
Completes Requests for Review (RFR) tasks accurately and timely.
Provides accurate correspondence after each case review.
Follows information security protocol policies and procedures in order to maintain the confidentiality of client records.
Maintains and updates case records and associated systems according to established policies and procedures.
Documents case record using automated equipment to establish a record for each client.
Communicates and facilitates verbally or in writing effectively and displays courtesy when interacting with internal or external customers.
Effectively and efficiently addresses, investigates and resolves complex CHIP and Appeal complaints and inquiries, problems, and questions received from internal and external customers regarding SNAP, Medicaid and CHIP program services.
Provides appropriate response through accurate interpretation of rules, regulations, and policies related to CHIP Programs.
Facilitates and coordinates within Health and Human Services (HHS) and other agencies to facilitate case resolution after case review actions have been completed.
Develops and maintains effective internal and external working relationships with agency staff, representatives, other state agencies, federal agencies, or the public.
Determines trends and resolves technical issues as it relates to the delivery of services to SNAP, Medicaid and CHIP clients.
Assists the supervisors with unit activities including (but not limited to), completion of case work to include work assigned to other staff, case reading, mentoring, completion of reports and assignments, and monitoring as assigned.
Assists with projects related to program initiatives, participate in projects, committees, or workgroups.
Performs other duties as assigned and required to maintain the operation of the unit.
This position will require travel up to 20% of the time.

Benefits

comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees
defined benefit pension plan
generous time off benefits
numerous opportunities for career advancement

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