Lead, Provider Recoupments & Holds — Hybrid Role

FALL CREEK FARM & NURSERY; Austin (TX); On-site; USD 50,000 - 66,000; Full time

Benefits offered by this job

Health insurance

Defined benefit pension

Generous time off

Job summary

The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services (MCS) department seeks a Program Specialist V for the Provider Recoupments and Holds unit. Some telework is available with on-site work required.

This role conducts data analysis on LTC authorizations, claim payments, holds, and recoupments. The position reports to the PRH Manager and requires strong Excel skills, policy knowledge, and customer-service experience.

Qualifications

• Graduation from an accredited four-year college or university with a major in business administration or related field.
• 4 years' experience working with LTC Medicaid processing systems.
• 4 years' experience analyzing LTC Medicaid claim payment and recoupment data.
• 4 years' experience working in a customer service environment, preferably in a call center or hotline.
• Advanced experience using Microsoft Excel.
• Ability to communicate effectively both verbally and in writing.

Responsibilities

• Research and analyze LTC Medicaid service authorizations, claim billing/payments, holds, and recoupments.
• Execute queries and analyze data; create reports for PRH; identify trends and issues.
• Develops and maintains standardized Excel tools or queries for PRH staff.
• Maintain PRH monthly KPI and SLA reporting; report metrics to PRH Manager.
• Provide customer service on LTC provider hotline and communicate with internal/external customers.

Skills

LTC Medicaid knowledge

Data analysis

Policy interpretation

Customer service

Effective communication

Education

Bachelor's degree in business administration or related field

Tools

Microsoft Excel

LTC systems

Job description

The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services (MCS) department seeks a Program Specialist V for the Provider Recoupments and Holds unit. Some telework is available with on-site work required.

This role conducts data analysis on LTC authorizations, claim payments, holds, and recoupments. The position reports to the PRH Manager and requires strong Excel skills, policy knowledge, and customer-service experience.