Remote-Eligible Lead, LTC Claims Recoupment & Holds

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

Benefits offered by this job

100% paid employee health insurance

Defined benefit pension

Generous paid time off

Career advancement opportunities

Job summary

The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services seeks a highly qualified Program Specialist V in the Provider Recoupments and Holds unit. The role involves senior-level analysis of LTC service authorizations, billing, hold, and recoupment processes, with partial telework and some on-site duties.

The successful candidate will run data queries, update policies, train staff, and collaborate across programs to resolve complex issues, while delivering customer service

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.

Responsibilities

• Research and analysis of LTC Medicaid service authorizations, claim billing and payments, claim holds, and recoupments.
• Execute queries and analyze data; create reports and identify trends for management review.
• Maintain monthly KPI and SLA reporting; identify trends and recommend improvements.
• Provide customer service via LTC provider hotline and communicate with internal and external stakeholders.
• Support policy development and staff training; participate in program projects and UAT for new systems.

Skills

LTC Medicaid knowledge

Data analysis

Excel proficiency

Microsoft Office

Communication skills

Problem solving

Policy interpretation

Education

Bachelor's degree in business or related field

Tools

Excel

Access

LTC applications

Job description

The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services seeks a highly qualified Program Specialist V in the Provider Recoupments and Holds unit. The role involves senior-level analysis of LTC service authorizations, billing, hold, and recoupment processes, with partial telework and some on-site duties.

The successful candidate will run data queries, update policies, train staff, and collaborate across programs to resolve complex issues, while delivering customer service