Medicaid Claims Specialist IV - Telework Eligible

FALL CREEK FARM & NURSERY; Austin (TX); Hybrid; USD 40,000 - 50,000; Full time

Benefits offered by this job

100% paid employee health insurance

Defined benefit pension

Generous time off benefits

Job summary

The Texas Health and Human Services Commission (HHSC) Medicaid & CHIP Services (MCS) unit seeks a Customer Service Representative in the Provider Claims Services (PCS) unit. This role reports to the PCS Program Supervisor and performs highly advanced customer service work in a call center environment dealing with Medicaid LTC providers and recipients.

The position involves researching and analyzing data across CARE, IDD Portal, SASO, TMHP LTC Portal, and a call tracking system to resolve claims

Qualifications

• Two years' experience in a call center or customer service environment.
• Preferred experience with Provider Claims Services systems.
• Preferred experience in researching and interpreting Medicaid policies and procedures.

Responsibilities

• Responds to inquiries regarding claims processing and billing issues for Medicaid LTC providers, recipients, agency case workers and eligibility staff via emails, reports, correspondence, or hotline.
• Researches and analyzes data within various automated systems to identify issues with claim processing/billing.
• Documents information in spreadsheets.
• Enters data, supporting records and actions taken to resolve billing or claims processing issues.
• Provides training to Medicaid providers on how to address or resolve issues in filing/processing claims.
• Interprets section policies and procedures for processing claims and service authorizations for LTC providers.

Skills

Customer service

Data entry

Microsoft Office

Communication

Tools

CARE

IDD Portal

SASO

TMHP LTC Portal

Call tracking system

Job description

The Texas Health and Human Services Commission (HHSC) Medicaid & CHIP Services (MCS) unit seeks a Customer Service Representative in the Provider Claims Services (PCS) unit. This role reports to the PCS Program Supervisor and performs highly advanced customer service work in a call center environment dealing with Medicaid LTC providers and recipients.

The position involves researching and analyzing data across CARE, IDD Portal, SASO, TMHP LTC Portal, and a call tracking system to resolve claims