Program Specialist IV

Texas Health & Human Services Commission•Austin, TX

1d•$4,263 - $5,521•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. Functional Title: Program Specialist IV Job Title: Program Specialist IV Agency: Health & Human Services Comm Department: Provider Claims Svcs (75/25) Posting Number: 21382 Closing Date: 09/25/2026 Posting Audience: Internal and External Occupational Category: Office and Administrative Support Salary Range: $4,263.16 - $5,521.16 Pay Frequency: Monthly Salary Group: TEXAS-B-20 Shift: Day Additional Shift: Telework: Eligible for Telework Travel: Up to 10% 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 Brief Job Description: The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Program Specialist IV in the Provider Claims Services (PCS) unit. PCS provides payment resolution support to Medicaid program and service providers of nursing facilities, hospice services, Community Living Assistance and Support Services (CLASS), Home and Community-Based Services (HCS), Texas Home Living (TxHmL), and rehabilitation and specialized services. The Program Specialist IV reports to the PCS Manager and provides highly complex (senior-level) program and technical assistance to agency program staff, Medicaid providers, and contractors to resolve service authorization and claims billing issues. This position initiates and leads efforts to resolve service authorization and claims billing issues through research, analysis, troubleshooting and testing of Long-Term Care (LTC) provider payment systems. The PSIV works to identify, communicate, and direct resolution of system-related issues impacting service authorizations or claims payments. The position makes recommendations to improve operations and develop policies, procedures, standards, and training on new system requirements. Essential Job Functions (EJFs): Serves as a subject matter expert (SME) for the PCS section. Develops and provides guidance on PCS processes and procedures and ensures effective coordination between PCS, Claims Management Division, and other HHS programs/areas. Monitors compliance with section and agency policies and procedures. Serves as back-up trainer for the PCS section. (25%) Conducts research and analysis of claims management system issues specializing in the HCS/TxHmL Programs. Coordinates and collaborates with program staff areas to resolve issues and develops recommendations for resolution or alternatives. Notifies stakeholders of business impact and provides updates on progress toward resolution of identified issues. (30%) Provides technical assistance by interpreting policies, procedures, rules and standards related to programs within claims management. Oversees or participates in user acceptance testing. Conducts training and provides guidance to staff in the development and integration of new or revised methods and procedures. (20%) Serves as a liaison to internal and external stakeholders to ensure appropriate coordination and adherence to policies, processes, and procedures. Facilitates meetings as needed with internal and external stakeholders. (15%) Performs related work and other duties as assigned for the PCS unit. Assists staff with troubleshooting technical issues related to call center operations. (10%)

Requirements

Knowledge of local, state, and federal policies and regulations related to Medicaid, Managed Care or Long-Term Care programs.
Knowledge of automated claims payment systems.
Knowledge of business or systems analysis standards including user acceptance testing methods.
Knowledge of all Programs that PCS data enters the SASO system.
Skill in using Microsoft Office products.
Skill in preparing written reports, technical or procedural materials.
Skill in researching, analyzing, interpreting, and synthesizing complex program data.
Ability to communicate effectively both verbally and in writing
Ability to gather, assemble, and analyze business requirements.
Ability to serve as a lead worker providing direction to others and ensuring deliverables are met.
Ability to develop and or maintain complex spreadsheets using Microsoft Excel.
Graduation from an accredited four-year college or university with major coursework in a relevant field preferred. Relevant experience may be substituted for each year of required education.
Experience in Medicaid, Managed Care or Long-Term Care, and 1915c waiver programs.
Experience working with automated claims payment processing systems.
Experience troubleshooting technical issues such as hardware, software, telephone, and/or applications/systems.
At least one year of experience in customer service.

Nice To Haves

Experience working in a call center preferred.

Responsibilities

Serves as a subject matter expert (SME) for the PCS section.
Develops and provides guidance on PCS processes and procedures and ensures effective coordination between PCS, Claims Management Division, and other HHS programs/areas.
Monitors compliance with section and agency policies and procedures.
Serves as back-up trainer for the PCS section.
Conducts research and analysis of claims management system issues specializing in the HCS/TxHmL Programs.
Coordinates and collaborates with program staff areas to resolve issues and develops recommendations for resolution or alternatives.
Notifies stakeholders of business impact and provides updates on progress toward resolution of identified issues.
Provides technical assistance by interpreting policies, procedures, rules and standards related to programs within claims management.
Oversees or participates in user acceptance testing.
Conducts training and provides guidance to staff in the development and integration of new or revised methods and procedures.
Serves as a liaison to internal and external stakeholders to ensure appropriate coordination and adherence to policies, processes, and procedures.
Facilitates meetings as needed with internal and external stakeholders.
Performs related work and other duties as assigned for the PCS unit.
Assists staff with troubleshooting technical issues related to call center operations.