Remote Senior Program Specialist - Medicaid Claims

Texas Health and Human Services; Austin (TX); On-site; USD 48,000 - 62,000; Full time

Benefits offered by this job

Health insurance

Pension plan

Time off

Career advancement

Job summary

Texas Health and Human Services Commission (HHSC) seeks a Program Specialist IV for the Provider Claims Services (PCS) unit in Austin. The role provides senior-level program and technical guidance on service authorizations and claims billing for LTC programs such as TxHmL, HCS, CLASS, and nursing facilities.

The PSIV will lead resolution efforts, analyze system issues, and develop training and policies to improve operations; telework is eligible, with in-office training required as needed.

Qualifications

• Graduation from an accredited four-year college or university; relevant experience may substitute for education.
• Experience in Medicaid, Managed Care or Long-Term Care programs.
• Experience with automated claims payment processing systems.
• Experience troubleshooting technical issues with hardware, software, or applications.

Responsibilities

• Serves as SME for the PCS section and guides processes and procedures.
• Researches claims management system issues and coordinates resolution.
• Provides technical assistance by interpreting policies and conducting training.
• Acts as liaison with stakeholders to ensure policy adherence and coordinate meetings.
• Troubleshoots call center operational issues and supports staff.

Skills

Medicaid knowledge

Claims systems

Analytical ability

Communication skills

Training capability

Spreadsheet proficiency

Education

Bachelor's degree

Tools

SASO system

Microsoft Office

Excel

Job description

Texas Health and Human Services Commission (HHSC) seeks a Program Specialist IV for the Provider Claims Services (PCS) unit in Austin. The role provides senior-level program and technical guidance on service authorizations and claims billing for LTC programs such as TxHmL, HCS, CLASS, and nursing facilities.

The PSIV will lead resolution efforts, analyze system issues, and develop training and policies to improve operations; telework is eligible, with in-office training required as needed.