Medicaid Claims Support Specialist IV

Texas Health and Human Services; Austin (TX); Hybrid; USD 40,000 - 50,000; Full time

Benefits offered by this job

Health insurance

Pension plan

Paid time off

Career advancement opportunities

Job summary

Texas Health and Human Services Commission (HHSC) seeks a Customer Service Representative in the Provider Claims Services unit to handle complex claims and billing for Medicaid LTC providers and recipients. The role reports to the PCS Program Supervisor and operates in a call-center environment.

Responsibilities include researching data across systems, resolving billing issues, and training providers on filing and processing claims. Telework may be possible under HHSC guidelines.

Qualifications

• Two years' experience in a call center or customer service environment.
• Preferred experience researching and interpreting Medicaid policies.

Responsibilities

• Responds to inquiries regarding claims processing and billing issues via emails, reports, correspondence, or hotline. Researches and analyzes data within automated systems to identify issues with claim processing/billing. Documents information in spreadsheets.
• Enters data and actions taken to resolve billing or claims processing issues using multiple systems (CARE, IDD Portal, SASO, TMHP LTC Portal, call tracking system).
• Provides training to Medicaid providers on addressing or resolving filing/processing claims.
• Interprets policies for processing claims and service authorizations; collaborates with PCS coaches to resolve complex issues.

Skills

Office equipment

Billing issue resolution

Microsoft Office

Excel

Policy interpretation

Verbal communication

Education

None

Tools

CARE system

IDD Portal

SASO

TMHP LTC Portal

Call tracking system

Job description

Texas Health and Human Services Commission (HHSC) seeks a Customer Service Representative in the Provider Claims Services unit to handle complex claims and billing for Medicaid LTC providers and recipients. The role reports to the PCS Program Supervisor and operates in a call-center environment.

Responsibilities include researching data across systems, resolving billing issues, and training providers on filing and processing claims. Telework may be possible under HHSC guidelines.