Program Specialist V
About The Position
The Texas Health and Human Services Commission (HHSC) seeks highly qualified candidates to fill a Program Specialist V position within the Claims Management Division, Provider Claims Services (PCS) contact center. Under the supervision of the PCS Manager, the Program Specialist V performs advanced technical work including training new staff and planning, developing, documenting, and implementing section policy and procedure related to service authorizations and payments in the Long-Term Care (LTC) Claims Management System (CMS). Researches section and technical requirements to resolve problems and recommends CMS improvements as needed. Escalates issues to the appropriate areas. Provides technical assistance to LTC regional and state program staff. Coordinates development and dissemination of claims payment information to provider agencies and staff. Performs testing on automated systems. Plans and implements section projects and oversees other staff as assigned. May be required to answer provider calls as necessary.
Requirements
- Knowledge of claims or payment processing systems/applications.
- Skill in reviewing/preparing technical documentation.
- Skill in analyzing data.
- Skill in testing automated systems.
- Ability to work with internal and external stakeholders.
- Ability to train/lead employees.
- Ability to communicate effectively both verbally and in writing.
- Ability to work independently and in teams.
- Ability to develop spreadsheets and reports using Microsoft Excel.
- Bachelor’s degree from an accredited college or university; or a high school diploma or equivalent and related full-time experience may substitute for the required education on an equivalent year-for-year basis.
- Experience in delivering staff training required.
- Experience testing automated systems required.
- Experience reviewing and preparing technical documentation required.
- Two or more years of work experience in a call center environment required.
- Two or more years of work experience with Medicaid for long-term care programs required.
Responsibilities
- Represents PCS at workgroups and meetings both internal and external to the agency. (20%)
- Provides training to new employees and “on demand” training when necessary. (20%)
- Participates in section and automation projects overseeing other staff as assigned. (20%)
- Acts as lead and provides technical assistance to regional and state staff and managed care organizations. (15%)
- Plans, analyzes, coordinates, and develops PCS section policies and procedures for LTC programs. (15%)
- Performs testing on automated systems. (10%)
- Attends work on regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
Benefits
- 100% paid employee health insurance for full-time eligible employees
- a defined benefit pension plan
- generous time off benefits
- numerous opportunities for career advancement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
