Program Specialist IV

TX-HHSC-DSHS-DFPS•Austin, TX

2d•$4,263 - $6,779•Onsite

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. Functional Title: Program Specialist IV Job Title: Program Specialist IV Agency: Health & Human Services Comm Department: Pharmacy Benefits Mgmt MMIS Posting Number: 18006 Closing Date: 06/29/2026 Posting Audience: Internal and External Occupational Category: Computer and Mathematical Salary Range: $4,263.16 - $6,779.25 Pay Frequency: Monthly Salary Group: TEXAS-B-20 Shift: Day Additional Shift: Telework: Not Eligible for Telework Travel: Up to 5% Regular/Temporary: Regular Full Time/Part Time: Full time FLSA Exempt/Non-Exempt: Nonexempt Facility Location: Job Location City: AUSTIN Job Location Address: 701 W 51ST ST Other Locations: MOS Codes: 16GX,60C0,611X,612X,63G0,641X,712X,86M0,8U000,OS,OSS,PERS,YN,YNS Job Description: The Program Specialist (PS) IV position is a journey-level position in the Pharmacy Rebates and Business Analysis (PRBA) section of the Vendor Drug Program (VDP) within Medicaid/CHIP Services (MCS) at Texas Health and Human Services. The PRBA section is responsible for ensuring that the pharmacy claims vendor meets contract requirements for processing claims and rebates, and coordinates with pharmacies, managed care organizations, and other trading partners to gather and provide the information needed to oversee and evaluate the Vendor Drug Program. This position is a point-of-sale claims analyst who prioritizes projects to implement policy changes, analyzes claim and system-related issues to provide solutions and coordinate implementation, and responds to requests for reports and data. Along with working to identify potential areas for process improvement initiatives to support development of automation, payment accuracy, audit activities, business rules, and processes and procedures. The claim analyst is responsible for the end-to-end process for any configuration and automation projects related to pharmacy claim and encounter processing. This position must be flexible and willing to take on new duties, including training other staff in a changing environment. This position works closely with the PRBA Claims Lead (PS V) to ensure implementation of projects. Works under general supervision with moderate latitude for the use of initiative and independent judgment. The position is required to work in the office building per scheduled days and subject to established policies. The selected candidate should be in the Austin area to meet the “in office” work requirement.

Requirements

Knowledge of the Texas Medicaid/CHIP Vendor Drug Program, its systems, and interfaces.
Perform in a demanding environment and work under pressure.
Ability to perform multiple detailed tasks on tight deadlines with a high degree of accuracy.
Organize, plan, and prioritize work activities, possess analytical and critical thinking skills.
Able to investigate complaints, recognizing problems, and working with others to facilitate solutions.
Troubleshoot claims adjudication problem areas.
Participate in major projects involving multiple program areas and IT systems.
Encourage and utilize suggestions and innovative ideas.
Conduct advanced research, analyze results, and prepare documents, reports, and correspondence.
Communicate clearly and concisely, both verbally and in writing to individuals of diverse backgrounds.
Ability to interpret and explain complex rules, regulations, and policies.
Utilize and access appropriate software (e.g., Microsoft: Word, Excel, Visio, PowerPoint, SharePoint) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position.
Ability to work well with others.
Bachelor’s degree from an accredited college or university. Related work experience may substitute for the required education on a year-for-year basis with a maximum substitution of four years.
Experience analyzing two of three areas: program, policy, or system changes.

Nice To Haves

Prefer two or more years of experience with Medicaid preferred.
Prefer knowledge of applicable claims processes (e.g., end-to-end claims cycle, auto-adjudication, manual work processes, payment methodologies, rework/adjustment processes).

Responsibilities

Provides research, analysis, evaluation, and technical assistance work for the VDP on pharmacy claims adjudication and MCO encounter transactions.
Continuously develop understanding of the systems and the relationships with internal and external trading partners and their systems to help troubleshooting issues, assess impact from policy changes, and coordinate changes with trading partners and other areas of the program.
Works with contracted vendors and other state staff to develop requirements for implementing program and policy changes.
Must be able to analyze requirements for any claim related projects.
Confers with staff on program issues and problems to identify and implement solutions.
Validates program and system changes through reviews and firsthand testing.
Troubleshoots issues and develops solutions involving delivery of client services and system functionality to coordinate quick and effective solutions regarding the pharmacy benefit.
Ability to pull and analyze reports necessary to support claim department needs.
Must have worked knowledge of National Council for Prescription Drug Programs (NCPDP) standards to maintain compliance with CMS.
Active involvement with NCPDP ensures the policies of the State are reflected in future standards developed by NCPDP.
The analysis and information from NCPDP will enable management to support decision-making.
Involves understanding and able to provide direction for updates to the NCPDP Post Adjudication Standard, TMHP Post Adjudication Companion Guide, the Quarterly TMHP/NCPDP External Code List (ECL), and other related documentation.
Works with HHSC Accounts Receivable and Accounts Payable departments on issues around warrants, quick vouchers, claim payment vouchers, budget codes, and other financial issues for pharmacy providers.
Participates in the development of program goals and objectives.
Monitors contracted vendors to ensure compliance with quality and performance requirements.
Familiar with the VDP system vendor contract to perform contact oversight duties.
Cross trains with other PRBA staff to serve as back-up.
Perform other duties as assigned or needed to maintain and improve unit operations.