Fair Hearings and Quality Assurance Specialist

Texas Health & Human Services Commission•Austin, TX

32d

About The Position

Medicaid and CHIP Services (MCS) at the Texas Health and Human Services Commission (HHSC) seeks a highly qualified candidate to fill the position of Program Specialist III. MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution to MCS's mission by providing moderately complex consultative and technical assistance for the Intellectual and Developmental Disabilities Program Eligibility and Support (IDD PES) unit. The Program Specialist III reports to the Unit Manager within IDD PES. The IDD PES team is responsible for ensuring eligible Texans are enrolled in programs serving individuals with intellectual and/or developmental disabilities. These programs include Home and Community-based Services (HCS), Texas Home Living (TxHmL), Community Living Assistance and Support Services (CLASS), the Intermediate Care Facilities for Individuals with Intellectual Disability or Related Condition (ICF/IID), and Community First Choice Non-Waiver (CFC NW). IDD PES staff authorize and verify programmatic eligibility for the listed programs. In addition, IDD PES staff process enrollments, transfers, suspensions, and terminations for HCS, TxHmL, and CLASS and coordinate and attend Fair Hearings. Under supervision of the Manager of Fair Hearings and Quality Assurance (QA/FH) in the Medicaid CHIP Services (MCS) Intellectual and Developmental Disability, Program Eligibility and Support (IDD PES) unit of the Health and Human Service Commission (HHSC), the Program Specialist III provides Fair Hearings support to unit staff and associated quality assurance data requests to direct supervisor. Work involves monitoring fair hearings and Medicaid eligibility inquiries and ensuring timely resolutions. Work involves developing recurring financial eligibility reports and other reporting duties as assigned. Collecting, organizing, and preparing materials for distribution in response to fair hearings. Assisting with the preparation of training materials including program rules, policy and procedure information to be shared with internal and/or external stakeholders. Working under general supervision with moderate latitude for the use of initiative and independent judgment.

Requirements

Skill in operating computers and applicable software
Knowledge of Medicaid wavier programs (such as CLASS, DBMD, HCS, TxHmL, or ICF/IID).
Knowledge of federal and state laws relating to long term care and/or other Medicaid and non-Medicaid services and programs.
Knowledge of program planning, evaluation, and implementation.
Skilled in organization and prioritization.
Ability to communicate effectively, both orally and in writing.
Ability to understand and follow policies and procedures.
Ability to maintain accurate files, records, and databases.
Ability to gather, assemble, correlate, and analyze information.
Ability to operate computers and experience using Microsoft Office and Adobe products.

Nice To Haves

Work experience within a Medicaid program (such as CLASS, DBMD, HCS, TxHmL, or ICF/IID) preferred
Experience working with the IDD Operations Portal, Long Term Care Online Portal (LTCOP) and Texas Integrated Eligibility Redesign (TIERS) systems preferred.
Experience using Microsoft Office and Adobe products.

Responsibilities

Supports those involved in Fair Hearings (FH) including unit staff, intra-agency staff, fair hearings officers, external stakeholders, and individuals terminating or being denied level of care (LOC) that prevents them from being eligible to receive IDD waiver program services
Monitor inquiries and provide technical assistance to internal and external stakeholders regarding fair hearings policies and procedures to resolve complex cases and address inquiries.
Develop recurring reports regarding financial eligibility for individuals who receive IDD Waiver program services and communicate loss or pending loss of Medicaid to unit staff in preparation for program termination.
Assist with implementation of routine quality assurance reporting and identify patterns in data to direct supervisor to support actions to improve accuracy and efficiency based on data.
Assist with updates of policies and procedures and assist as needed.

Benefits

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.

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