Premium Payable System Program Specialist VII Program Enrollment & Support

TX-HHSC-DSHS-DFPS•Austin, TX

5d•$5,798 - $9,508•Hybrid

About The Position

The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services (MCS) department seeks a highly qualified candidate to fill the Program Specialist VII position in Program Enrollment and Support, Premiums Payable System. 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 managing day-to-day operations and oversight of the Premiums Payable System while coordinating on related system projects and updates with stakeholders as required. The Premium Payable System division of Program Enrollment and Support is responsible for ensuring the system is issuing appropriate dollar amounts, identifying performance trends, and evaluating improvement activities or remedies. Performs highly advanced consultative and technical assistance in the development of managed care payment methodology and performing data analysis to evaluate the performance of contracted Managed Care Organizations (MCOs) for Medicaid Managed Care and CHIP programs. The Program Specialist VII position involves significant amount of planning, developing, coordinating, and implementing agency programs and providing consultative services and significant technical assistance to program staff, governmental agencies, community organizations, or the public. Ensures compliance with agency policies and standards, processes, and procedures. Manages cross-division collaboration to ensure horizontal and vertical communication, appropriate project prioritization, and effective resource utilization. Serves as the subject matter expert in assigned workgroups and other activities with respect to the Premiums Payable System operations. Works directly with the IT to coordinate, develop, document, and review processes and changes. The ideal candidate possesses exceptional analytical and technical skills, including advanced proficiency in SQL, Microsoft Access Database, and Microsoft Excel. The successful candidate demonstrates the ability to independently analyze large datasets, identify trends and anomalies, develop complex queries, troubleshoot data issues, communicate technical findings to both technical and non-technical audiences. The ideal candidate thrives in an environment that emphasizes critical thinking and problem solving, teamwork to achieve goals, integrity, excellence through high professional standards and personal accountability, and curiosity to continuously grow and learn. This position reports to the Director III of Enrollment Operations and works under limited supervision, with considerable latitude for the use of initiative and independent judgment.

Requirements

Knowledge of Medicaid and CHIP managed care enrollment policy and processes.
Knowledge of local, state, and federal laws related to the program area; of public administration and management techniques; of statistical analysis processes; of budget processes; of research techniques; of training and marketing techniques; and of program management processes and techniques.
Skill in analyzing large datasets to identify trends, anomalies, operational issues, and opportunities for process improvement.
Extensive skills in using personal computer application software such as Access Database, MicroStrategy, Microsoft Word, Power Point, Excel, Microsoft Project or similar programs.
Skill in identifying measures or indicators of program performance and in operating computers and applicable software.
Skill in coordinating with multiple stakeholders.
Skill in coordinating team member actions operating in direct support of the Premiums Payable System activities and team members responsible for resolving Medicaid and CHIP eligibility and managed care enrollment issues.
Skill in written and oral communication.
Ability to analyze large data sets using SQL, Microsoft Access Database, and Microsoft Excel.
Ability to evaluate impacts that policy and program changes may have on Medicaid and CHIP MCO capitation payments.
Ability to manage projects and work groups to facilitate the implementation of changes to managed care MCO capitation.
Ability to gather, assemble, correlate, and analyze facts; to devise solutions to problems; to market programs; to prepare reports; to develop, evaluate, and interpret policies and procedures; to communicate effectively; and prioritize workload.
Ability to work cooperatively as a team member in a rapid-paced, deadline-oriented environment.
At least two years’ experience in a position related to data trending and analysis.
Bachelor’s degree from an accredited college or university. Educational requirements are transferable with relevant work experience on a year-for-year basis.

Nice To Haves

Advanced proficiency in SQL, Microsoft Access Database, and Microsoft Excel.
Ability to independently analyze large datasets, identify trends and anomalies, develop complex queries, troubleshoot data issues, communicate technical findings to both technical and non-technical audiences.
Thrives in an environment that emphasizes critical thinking and problem solving, teamwork to achieve goals, integrity, excellence through high professional standards and personal accountability, and curiosity to continuously grow and learn.

Responsibilities

Performs complex analysis of MCO capitation data and prepares statistical reports and findings, trends the performance data, answers inquiries and provides reports and technical recommendations to MCOs.
Manages complex projects including audits of Premium Payment System (PPS) and manages risk group system rules to align with Managed Care Program changes.
Analyzes the impact of state/federal laws and regulations on operational processes. Identifies the need for new requirements for programs to mitigate risk.
Develops and maintains the necessary procedural documents to communicate the operational dependencies of the section's business functions.
Improves management controls and operations efficiency by developing and implementing effective techniques and analysis tools including administrative reports, and specialized research projects. This function requires compiling written records.
Provides professional communications to Medicaid and CHIP health plans, the Enrollment Broker, HHSC staff, other state agencies and external associations on managed care and PPS operations.
Coordinates with other functional areas on changes impacting Program Enrollment and Support (PES) activities, including interfaces with eligibility systems (TIERS) and the Service Authorization System (SAS) in addition to other trading partner automated systems.