Quality Assurance MEPD Specialist II

TX-HHSC-DSHS-DFPS•Bryan, TX

11d•Hybrid

About The Position

The Texas Health and Human Services Commission (HHSC) seeks highly qualified candidates to fill the Quality Assurance Specialist II OPSM position within the Access and Eligibility Services. The Access and Eligibility Services section is driven by its mission to connect Texans to services by helping individuals and families in need of food, medical care, cash assistance and other social services. This position involves the use of analysis, wisdom, experience and judgment to determine the accuracy of case actions. The ideal candidate will thrive in an environment that emphasizes: innovation through new ideas, striving for excellence by taking pride in your work, embracing our differences as a source of strength, accomplishing more through partnership, leading by example, and learning for continuous improvement. The candidate will report to a Field Manager in Quality Assurance Field Services (QAFS), within the Quality Management section of the Eligibility Services: Support Division. Quality Management is responsible for ensuring casework completed is of acceptable quality, and benefits provided to clients are accurate. Quality Assurance Field Services is comprised of one Area Manager, one Area Lead, and one Section Lead and eleven Field Managers, each managing a unit consisting of one Quality Assurance Specialist II and up to ten Quality Assurance Specialists I. The candidate will work with the Field Manager as part of a team to ensure unit objectives are achieved. The position involves performing and monitoring complex social services case analysis and auditing functions to assess the accuracy relating to the program policies and procedures, specifically the Medicaid for the Elderly and People with Disabilities (MEPD) and the Supplemental Nutritional Assistance Program (SNAP) programs. This includes reviewing and analyzing service delivery methods, information systems, and case information to ensure compliance with state statutes and internal regulations and recommend improvements. These results will be reported in an organized method. This position will assist in analyzing the findings to develop an action plan for improvement. Individual is responsible for assisting the Unit Field Manager as needed in relation to coordinating and scheduling the process to review system information and eligibility determination. Provides technical and consultative work in the planning, developing, and implementation of agency programs, policies, and procedures. May train others. The Quality Assurance Specialist II – OPSM will work under general supervision, with limited latitude for the use of initiative and independent judgement.

Requirements

Knowledge of Medicaid Eligibility for the Elderly and People with Disabilities policies and procedures.
Knowledge of SNAP policies and procedures.
Knowledge of agency policies, operating methods, and procedures.
Knowledge or organizational operations.
Knowledge of public administrations and management techniques.
Knowledge of program planning and implementation.
Skill in attention to detail and discerning accuracy of information.
Skill in data analysis and report production.
Skill in organization, analysis, and problem solving.
Ability to organize assigned work and develop effective work methods.
Ability to evaluate procedures and policies and identify areas for improvement.
Ability to produce accurate work and meet deadlines.
Ability to work independently and make independent judgments.
Ability to gather, assemble, correlate, and analyze findings.
Ability to prepare correspondence and reports.
Ability to select and evaluate information in relating to business processes and eligibility determination.
Ability to communicate orally and in writing.
Ability to develop and maintain effective working relationships with others.
Ability to provide leadership and organizational advice.
Must be a current HHSC AES employee.
Must be able to travel a minimum of 20%.
Must have completed MEPD BST Part I and Part II.
Must have a minimum of three years’ experience interpreting and applying Medicaid Eligibility for the Elderly and People with Disabilities (MEPD) policy (including community, facility, and waiver programs) in the past four years.
Must have current TIERS and EWMS experience related to eligibility determinations or review.

Nice To Haves

Experience applying and/or interpreting SNAP policy preferred.
Experience case reading in PIMS is preferred.

Responsibilities

Evaluates completeness, accuracy, and required documentation for Quality Assurance Field Services activities and projects via auditing of reviews conducted by QAFS staff (40%).
Collects, organizes and analyzes error data as identified through case review in order to identify trends (20%).
Documents, prepares, and provides reports as assigned to management staff. (20%).
Assists Unit Supervisor in preparing and distributing statistical reports summarizing unit findings to Office of Program Support and Monitoring and Office of Eligibility Services management staff, coordinating unit assignments, monitoring unit completion of assignments, and training unit staff as needed (10%).
Performs related work as assigned (10%).

Benefits

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.

Stand Out From the Crowd

Upload your resume and get instant feedback on how well it matches this job.

Upload and Match Resume