Program Specialist II

Texas Health & Human Services Commission•Austin, TX

2d•$3,793 - $5,921•Hybrid

About The Position

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage. Program Specialist II provides complex technical assistance and consultative services to facility reimbursement staff located in the state hospitals. Provides oversight of Medicaid, Medicare, third party insurances and other claims activity performed by reimbursement staff. Assists in planning, analyzing, developing, implementing, monitoring, and problem solving for reimbursement programs. Position completes third party credentialing applications, assist with desk audits and resolving issues with reimbursement staff.

Requirements

High school diploma/GED (Required)
Experience with Third-party credentialing processes and contracts. (Required)
Knowledge with various third-party programs such as Medicare, Medicaid, and private health insurance.
Knowledge with health-related accounting and collection procedures.
Knowledge with medical claims submission and reconciliation.
Skills in advanced skills in using computer software, including but not limited to Outlook, Word, and Excel.
Proficient in effectively managing, reconciling and/or reporting accounts receivables.
Proficient in developing and/or implementing complex reporting specifications.
Ability to communicate effectively verbally and in writing.
Ability to learn how to interpret, and apply state and federal rules, regulations, policies and procedures.
Ability to learn Electronic Health Records systems such as Avatar.
Ability to establish and maintain effective working relationships with others.

Nice To Haves

Experience with third-party payors, Medicaid, and Medicare claims processing. (Preferred)
Experience Liaising with third-party payors to maintain the contracts/credentialing. (Preferred)
Experience with internal desk audits of claim payments and denials. (Preferred)
Experience with the Texas Administrative Codes rules and regulations. (Preferred)

Responsibilities

Provides oversight, assistance and support for maximizing revenues in the reimbursement programs; and identifies and assists with resolving billing and payment problems.
Collaborates with state hospital staff to resolve issues with Medicaid, Medicare or third party payors claims and initiates corrective action with appropriate agency on problems as needed.
Advises Reimbursement staff on necessary action to obtain eligibility, claims processing and prevent loss of revenue.
Maintains liaison with Medicare and Medicaid fiscal intermediaries, carriers, and other governmental and private entities to ensure successful and appropriate claims processing.
Assists with Medicare and Medicaid Provider enrollment.
Assists the development of policy, procedures manual, and special forms.
Completes third party credentialing applications.
Assist with desk audits and resolving issues with reimbursement staff.