Provider Enrollment Specialist

TX-HHSC-DSHS-DFPS•Austin, TX

1d•Hybrid

About The Position

The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department is seeking a highly qualified candidate to fill the position of Program Specialist V (PE Specialist) in the Provider Enrollment (PE) unit. The ideal candidate thrives in an environment that emphasizes teamwork, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity. Under the supervision of the Provider Enrollment Manager, the Program Specialist V will act as a provider enrollment expert, focusing on PE program operations, policies and workflows in a fast-paced, evolving environment. Responsibilities include researching and interpreting policies, procedures, rules, regulations, guidance, and standards related to Medicaid provider enrollment daily operations. The role involves providing operational and technical assistance to program staff, PE staff, providers, and State Medicaid contractors. Work includes preparing, editing, and routing communications for providers and managed care organizations, reviewing and making determinations in the Provider Enrollment Management System (PEMS) for Operations Management (OM) requests, and identifying the root causes of processing delays and errors to make recommendations for gap coverage or backdate enrollments. The specialist offers customer service and assists with monitoring the provider enrollment shared mailbox. They conduct thorough research and analysis of complex inquiries and complaints from various stakeholders using HHSC/TMHP/E-OPM Internet computer systems and other resources, and act as a liaison among clients, providers, and contractors to make decisions and resolve issues. The position may also assist with PE reporting, review the Texas Medicaid Provider Procedures Manual, serve as backup in PE work groups, and train others.

Requirements

Knowledge of the Texas Medicaid program.
Knowledge of customer relations principles and practices.
Knowledge of health and human services programs.
Skill in managing multiple and competing priorities.
Skill in researching, developing, analyzing, and evaluating complex program and policy issues.
Skill in the use of computer and related equipment, including the use of Microsoft Office Suite or equivalent to include word processing, spreadsheet, database, or presentation software programs.
Ability to identify problems, evaluate alternatives, and implement effective solutions.
Ability to communicate effectively orally and in writing.
Ability to coordinate with other staff, departments, officials, agencies, organizations, and the public.
Ability to review and interpret rules.
Ability to lead workgroups, projects, and meetings.
Minimum of 1-year experience researching and evaluating policies or processes for supporting healthcare operations and administrative functions.
Minimum of 2 years’ experience working in provider/customer service, leading workgroups, projects, and meetings.

Nice To Haves

Graduation from an accredited four-year college or university with major course work in Social Sciences (Sociology, Psychology, or Social Work), Health Information Management, Business Administration, or Healthcare Administration / Health Services Administration is preferred.

Responsibilities

Assists the Provider Enrollment unit with PE-related questions and complaints.
Works with internal and external stakeholders, including contracted vendors, to research and resolve provider questions and complaints.
Responds to legislative and external inquiries and requests.
Participates in other workgroup meetings.
Communicates with industry stakeholder groups such as provider associations and health plan associations.
Drafts and reviews guidance and notices to providers with program updates.
Provides technical assistance to program and PE staff, providers, and State Medicaid contractors.
Provides support for updating PE program manuals when operational changes are needed.
Interprets policies, procedures, rules, regulations, and standards to make recommendations on operational requests.
Assists and represents PE in workgroups and meetings to disseminate information on PE policy and programmatic initiatives.
Prepares agenda, facilitates discussions, and maintains effective working relationships with PE representatives.
Leads and participates in operational projects affecting the unit.
Coordinates with other program areas with minimal oversight.
May train others.
May assist with PE reporting and review the Texas Medicaid Provider Procedures Manual and other documents.
May serve as backup in PE work groups.