Senior Program Specialist, Medicaid Claims & LTC

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

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.