PASRR Specialized Services Policy Reviewer

Texas Health and Human Services; Austin (TX); Hybrid; USD 50,000 - 66,000; Full time

Benefits offered by this job

Telework eligible

Job summary

Texas Health and Human Services Commission in Austin seeks a Program Specialist V to support PASRR specialized services review, adjudication, and authorization. You will interpret policies, assist providers, and ensure timely processing of claims related to PASRR services.

The role emphasizes collaboration, accuracy, and policy clarity, with telework eligibility and a focus on specialized services authorization. Strong analytical and communication skills are essential.

Qualifications

• Graduation from an accredited four-year college or university with major course work in a human services field.
• One year of relevant experience may be substituted for each year of required education.
• At least 2 years of experience in the IDD services field is preferred.
• Experience reviewing documentation, analyzing authorization or claims issues, and supporting resolution of complex payment concerns is preferred.

Responsibilities

• Review, adjudicate, and authorize requests for nursing facility specialized services and IDD habilitative services for PASRR-eligible individuals in nursing facilities.
• Provide technical assistance and policy clarification to external providers on PASRR procedures, policies, and rules.
• Assist with developing program and quality monitoring policies related to prior authorization of PASRR specialized services.
• Participate in work groups and TMHP LTC portal initiatives such as user acceptance testing (UAT).
• Complete other work as assigned by the PASRR Policy Manager or PASRR Specialized Services Lead.

Skills

PASRR knowledge

Claims processing concepts

Organizational skills

Analytical skills

Attention to detail

Communication skills

Microsoft Office

Independent & collaborative work

Excel

Education

Bachelor's degree in human services

Tools

TMHP LTC Online Portal

Microsoft Excel

Job description

Date: Aug 21, 2026

Location: AUSTIN, TX

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. 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. Explore more details on the Benefits of Working at HHS webpage.

Job Details

• Functional Title: PASRR Specialized Services Policy Reviewer
• Job Title: Program Specialist V
• Agency: Health & Human Services Comm
• Department: PASRR
• Closing Date: 11/19/2026
• Occupational Category: Community and Social Services
• Salary Range: $4,523.16 - $5,888.50
• Pay Frequency: Monthly
• Salary Group: TEXAS-B-21
• Shift: Day
• Telework: Eligible for Telework
• Travel: Regular
• Regular/Temporary: Regular
• Full Time/Part Time: Full time
• FLSA Exempt/Non-Exempt: Nonexempt
• Facility Location:
• Job Location City: AUSTIN
• Job Location Address: 701 W 51ST ST
• Other Locations:
• MOS Codes: 16GX,60C0,611X,612X,63G0,641X,712X,86M0,8U000,OS,OSS,PERS,YN,YNS

Nearest Major Market: Austin

The Program Specialist V position reports to the Pre-Admission Screening and Resident Review (PASRR) Manager within the Intellectual and Developmental Disability (IDD) Services and PASRR Section. This position performs highly complex senior-level work and is responsible for assisting the manager and the PASRR Specialized Services Lead with reviewing, adjudicating, and authorizing requests for specialized services under the PASRR program. The position evaluates supporting documentation, applies applicable PASRR policies and rules, and determines whether requests meet requirements for authorization. This position also provides technical assistance and policy clarification to stakeholders and providers on procedures, policies, and rules related to PASRR, with an emphasis on specialized services authorization and related claims or payment issues. The position identifies, communicates, and supports resolution of documentation or system issues that may affect service authorizations, claims or payments. Works under limited supervision, with moderate latitude for the use of initiative and independent judgment.

Ideal candidates should be comfortable with change, skilled at navigating ambiguity, and capable of quickly pivoting when systems or processes prove ineffective or inefficient.

Essential Job Functions

• (50%) Review, adjudicate, and authorize requests for nursing facility specialized services and IDD habilitative specialized services for PASRR-eligible people living in nursing facilities. Ensure requests are reviewed accurately and within required timeframes using automated and manual processes and verify that supporting documentation meets PASRR specialized services authorization requirements.
• (30%) Provide technical assistance and policy clarification to external providers on PASRR procedures, policies, and rules, including requests for nursing facility specialized services submitted through the TMHP Long Term Care (LTC) Online Portal and IDD habilitative specialized services processed through manual procedures. Assist providers and stakeholders in understanding documentation requirements, authorization outcomes, and issues that may affect PASRR specialized services authorization, claims processing or payment.
• (10%) Assist with developing program and quality monitoring policies and procedures related to prior authorization of PASRR specialized services. Produce reports of findings, trends, authorization outcomes, and claims-related issues to support monitoring, process improvement, and compliance with PASRR specialized services requirements.
• (5%) Participate in work groups and TMHP LTC online portal initiatives such as user acceptance testing (UAT) on enhancements to the portal.
• (5%) Complete other work as assigned by the PASRR Policy Manager or PASRR Specialized Services Lead.

Knowledge, Skills And Abilities

• Knowledge of PASRR processes, policies, regulations, and specialized services authorization requirements.
• Knowledge of reimbursement claims processing concepts, and factors that may affect claims payment for authorized services.
• Strong organizational and time management skills to handle workload and deadlines.
• Analytical and problem-solving skills to review service requests, evaluate supporting documentation, and identify authorization or claim-related issues.
• Attention to detail and accuracy.
• Excellent communication skills to provide technical assistance and clarification to various stakeholders.
• Skills in using Microsoft Office products.
• Ability to work independently and collaboratively in a fast-paced environment.
• Ability to communicate effectively both verbally and in writing.
• Ability to gather, assemble, and analyze business requirements.
• Ability to develop and or maintain complex spreadsheets using Microsoft Excel.

Registrations, Licensure Requirements Or Certifications

N/A

Initial Screening Criteria

• Graduation from an accredited four-year college or university with major course work in a human services field is required. One year of relevant experience may be substituted for each year of required education.
• At least 2 years of experience in the IDD services field is preferred.
• Experience reviewing documentation, analyzing authorization or claims issues, and supporting resolution of complex payment concerns is preferred.
• Experience working at a LIDDA or IDD provider is preferred.

Active Duty, Military, Reservists, Guardsmen, And Veterans

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks And Work Eligibility

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks. HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer

This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.