Program Specialist IV

FALL CREEK FARM & NURSERY; Austin (TX); On-site; USD 48,000 - 62,000; Full time

Benefits offered by this job

Telework eligible

100% paid employee health insurance

Defined benefit pension plan

Generous time off benefits

Career advancement opportunities

Job summary

The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services seeks a Program Specialist IV in Provider Claims Services (PCS). The role provides senior-level program and technical guidance to resolve service authorization and claims billing issues for LTC, HCS, TxHmL, and related programs.

The PSIV reports to the PCS Manager and leads complex problem resolution, policy development, and training on new system requirements, across multiple programs and stakeholders.

Qualifications

• Graduation from an accredited four-year college or university preferred.
• Experience with Medicaid, Managed Care or Long-Term Care programs preferred.
• Experience with automated claims payment processing systems.
• Ability to troubleshoot hardware, software, or application issues and provide user support.

Responsibilities

• Serve as SME for the PCS section and coordinate with internal teams.
• Research and analyze claims management system issues and coordinate resolutions.
• Provide technical assistance interpreting policies and oversee testing/user acceptance.
• Facilitate meetings with internal and external stakeholders to ensure policy adherence.
• Assist staff with troubleshooting technical issues related to call center operations.

Skills

Microsoft Excel

Analytical thinking

Verbal & written communication

Lead worker capability

Education

Bachelor's degree

Tools

SASO system

Automated claims payment systems

Job description

Posting ID21382-Posted09/11/2026-Health & Human Services Comm-Provider Claims Svcs (75/25)-Office and Administrative Support-Eligible for Telework-b. $3000 - $4999 per month

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 .

Functional Title:Program Specialist IVJob Title:Program Specialist IVAgency:Health & Human Services CommDepartment:Provider Claims Svcs (75/25)Posting Number:21382Closing Date:09/25/2026Posting Audience:Internal and ExternalOccupational Category:Office and Administrative SupportSalary Range:$4,263.16-$5,521.16Pay Frequency: MonthlySalary Group:TEXAS-B-20Shift:DayAdditional Shift:NoneTelework:Eligible for TeleworkTravel:Up to 10%Regular/Temporary:RegularFull Time/Part Time:Full timeFLSA Exempt/Non-Exempt:NonexemptFacility Location: Job Location City:AUSTINJob Location Address:701 W 51ST STOther Locations:NoneMOS Codes: 16GX,60C0,611X,612X,63G0,641X,712X,86M0,8U000,OS,OSS,PERS,YN,YNS

Brief Job Description:

The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Program Specialist IV in the Provider Claims Services (PCS) unit. PCS provides payment resolution support to Medicaid program and service providers of nursing facilities, hospice services, Community Living Assistance and Support Services (CLASS), Home and Community-Based Services (HCS), Texas Home Living (TxHmL), and rehabilitation and specialized services.

The Program Specialist IV reports to the PCS Manager and provides highly complex (senior-level) program and technical assistance to agency program staff, Medicaid providers, and contractors to resolve service authorization and claims billing issues.

This position initiates and leads efforts to resolve service authorization and claims billing issues through research, analysis, troubleshooting and testing of Long-Term Care (LTC) provider payment systems. The PSIV works to identify, communicate, and direct resolution of system-related issues impacting service authorizations or claims payments. The position makes recommendations to improve operations and develop policies, procedures, standards, and training on new system requirements.

Essential Job Functions (EJFs):

• Serves as a subject matter expert (SME) for the PCS section. Develops and provides guidance on PCS processes and procedures and ensures effective coordination between PCS, Claims Management Division, and other HHS programs/areas. Monitors compliance with section and agency policies and procedures. Serves as back-up trainer for the PCS section. (25%)
• Conducts research and analysis of claims management system issues specializing in the HCS/TxHmL Programs. Coordinates and collaborates with program staff areas to resolve issues and develops recommendations for resolution or alternatives. Notifies stakeholders of business impact and provides updates on progress toward resolution of identified issues. (30%)
• Provides technical assistance by interpreting policies, procedures, rules and standards related to programs within claims management. Oversees or participates in user acceptance testing. Conducts training and provides guidance to staff in the development and integration of new or revised methods and procedures. (20%)
• Serves as a liaison to internal and external stakeholders to ensure appropriate coordination and adherence to policies, processes, and procedures. Facilitates meetings as needed with internal and external stakeholders. (15%)
• Performs related work and other duties as assigned for the PCS unit. Assists staff with troubleshooting technical issues related to call center operations. (10%)

Knowledge, Skills and Abilities (KSAs):

• Knowledge of local, state, and federal policies and regulations related to Medicaid, Managed Care or Long-Term Care programs.
• Knowledge of automated claims payment systems.
• Knowledge of business or systems analysis standards including user acceptance testing methods.
• Knowledge of all Programs that PCS data enters the SASO system.
• Skill in using Microsoft Office products.
• Skill in preparing written reports, technical or procedural materials.
• Skill in researching, analyzing, interpreting, and synthesizing complex program data.
• Ability to communicate effectively both verbally and in writing
• Ability to gather, assemble, and analyze business requirements.
• Ability to serve as a lead worker providing direction to others and ensuring deliverables are met.
• 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 coursework in a relevant field preferred. Relevant experience may be substituted for each year of required education.
• Experience in Medicaid, Managed Care or Long-Term Care, and 1915c waiver programs.
• Experience working with automated claims payment processing systems.
• Experience troubleshooting technical issues such as hardware, software, telephone, and/or applications/systems.
• Experience working in a call center preferred.
• At least one year of experience in customer service.

Additional Information:

• 1. Your application must be complete and contain all the requested information. Job histories must demonstrate how you meet the initial selection criteria at a minimum.
• 2. Any employment offer is contingent upon available budgeted funds. The salary offered will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual.
• 3. Applicants must live or be willing to relocate to the Austin area as training is done in office.

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 tothose 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.