Program Specialist V

Texas Health & Human Services Commission•Austin, TX

33d•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. The Program Specialist V position is a senior 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 Program Specialist V is responsible for ensuring that the pharmacy claims vendor meets contract requirements for processing pharmacy claims and managed care organizations (MCOs) encounter transactions. This position prioritizes and coordinates projects with VDP vendors and trading partners to implement policy changes within the VDP systems. Analyzes system and program changes, or issues, to provide solutions and coordinate their implementation. Oversee vendor test plans and participate in user acceptance testing. Performs highly complex consultative services and provides senior level technical assistance. Participates in meetings with vendors and trading partners of the VDP. Interprets and explains orally and in writing Medicaid rules, regulations, policies, and procedures related to the VDP automated systems. 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.
Ability to interpret and explain complex rules, regulations, and policies.
Knowledge of National Council for Prescription Drug Programs (NCPDP) standards for pharmacy transactions.
Ability to lead projects involving multiple programs and IT systems.
Ability to communicate clearly both verbally and in writing.
Ability to organize and develop work plans, coordinate administrative assignments and adhere to strict deadlines.
Ability to perform multiple detailed tasks on tight deadlines with a high degree of accuracy.
Skill in investigating complaints, recognizing problems, and working with others to facilitate solutions.
Skill in conducting research, analyzing the results, and preparing documents, reports, and correspondence.
Skill in using the following tools: Microsoft Word, Excel, PowerPoint, Visio, Project, Access or other software tools.
Bachelor's degree from an accredited college or university. Experience and education may be substituted for one another on a year for year basis.
Three or more years of experience with Medicaid.

Nice To Haves

Experience analyzing program, policy and/or system changes preferred.

Responsibilities

Provides advanced research, analysis, evaluation, and technical assistance work for VDP on pharmacy claims adjudication and MCO encounter transactions. Continuously develops understanding of the systems and the relationships with internal and external trading partners and their systems to provide expertise in troubleshooting issues, assessing impact from policy changes, and coordinating changes with trading partners and other areas of the program. Knowledge of the VDP pharmacy claim and the encounter claim edits. Works with contracted vendors and other state staff to develop requirements for implementing program and policy changes.
This position must have working 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 the Program Specialist V 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. Attend NCPDP task group sessions and the in person at the annual NCPDP conference.
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.
Leads projects and coordinates with other areas to ensure that policy and program changes are implemented. Validates program and system changes through reviews and testing.
Troubleshoots issues and develops solutions involving delivery of client services and system functionality to coordinate quick and effective solutions.
Provides reports for management and trading partners both internal and external using data from VDP and other Texas Medicaid Management Information System (TMMIS) applications.
Experience with developing processes and procedures.
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.