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About the Role

The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services (MCS) department seeks a highly qualified candidate to fill the Program Specialist VII position in Program Enrollment and Support, Premiums Payable System. This position makes a significant contribution to MCS’s mission by managing day-to-day operations and oversight of the Premiums Payable System while coordinating on related system projects and updates with stakeholders as required.

Responsibilities

Performs complex analysis of MCO capitation data and prepares statistical reports and findings, trends the performance data, answers inquiries and provides reports and technical recommendations to MCOs.
Manages complex projects including audits of Premium Payment System (PPS) and manages risk group system rules to align with Managed Care Program changes.
Analyzes the impact of state/federal laws and regulations on operational processes.
Identifies the need for new requirements for programs to mitigate risk.
Develops and maintains the necessary procedural documents to communicate the operational dependencies of the section's business functions.
Improves management controls and operations efficiency by developing and implementing effective techniques and analysis tools including administrative reports, and specialized research projects.
Provides professional communications to Medicaid and CHIP health plans, the Enrollment Broker, HHSC staff, other state agencies and external associations on managed care and PPS operations.
Coordinates with other functional areas on changes impacting Program Enrollment and Support (PES) activities, including interfaces with eligibility systems (TIERS) and the Service Authorization System (SAS) in addition to other trading partner automated systems.
Manages day-to-day operations and oversight of the Premiums Payable System.
Coordinates on related system projects and updates with stakeholders.
Ensures the system is issuing appropriate dollar amounts, identifying performance trends, and evaluating improvement activities or remedies.
Performs highly advanced consultative and technical assistance in the development of managed care payment methodology.
Performs data analysis to evaluate the performance of contracted Managed Care Organizations (MCOs) for Medicaid Managed Care and CHIP programs.
Manages cross-division collaboration to ensure horizontal and vertical communication, appropriate project prioritization, and effective resource utilization.
Serves as the subject matter expert in assigned workgroups and other activities with respect to the Premiums Payable System operations.
Works directly with the IT to coordinate, develop, document, and review processes and changes.

Requirements

At least two years’ experience in a position related to data trending and analysis.
Bachelor’s degree from an accredited college or university.
Educational requirements are transferable with relevant work experience on a year-for-year basis.
Must bring I-9 documentation on the first day of work.
Applicants selected for hire may be required to pass background and other due diligence checks.

Skills

Advanced proficiency in SQL.
Advanced proficiency in Microsoft Access Database.
Advanced proficiency in Microsoft Excel.
Ability to independently analyze large datasets.
Ability to identify trends and anomalies.
Ability to develop complex queries.
Ability to troubleshoot data issues.
Ability to communicate technical findings to both technical and non-technical audiences.
Critical thinking.
Problem solving.
Teamwork.
Integrity.
Excellence through high professional standards and personal accountability.
Curiosity to continuously grow and learn.
Analyzing large datasets to identify trends, anomalies, operational issues, and opportunities for process improvement.
Extensive skills in using personal computer application software such as Access Database, MicroStrategy, Microsoft Word, Power Point, Excel, Microsoft Project or similar programs.
Identifying measures or indicators of program performance.
Operating computers and applicable software.
Coordinating with multiple stakeholders.
Coordinating team member actions operating in direct support of the Premiums Payable System activities and team members responsible for resolving Medicaid and CHIP eligibility and managed care enrollment issues.
Written and oral communication.
Ability to analyze large data sets using SQL, Microsoft Access Database, and Microsoft Excel.
Ability to evaluate impacts that policy and program changes may have on Medicaid and CHIP MCO capitation payments.
Ability to manage projects and work groups to facilitate the implementation of changes to managed care MCO capitation.
Ability to gather, assemble, correlate, and analyze facts.
Ability to devise solutions to problems.
Ability to market programs.
Ability to prepare reports.
Ability to develop, evaluate, and interpret policies and procedures.
Ability to prioritize workload.
Ability to work cooperatively as a team member in a rapid-paced, deadline-oriented environment.
Knowledge of Medicaid and CHIP managed care enrollment policy and processes.
Knowledge of local, state, and federal laws related to the program area.
Knowledge of public administration and management techniques.
Knowledge of statistical analysis processes.
Knowledge of budget processes.
Knowledge of research techniques.
Knowledge of training and marketing techniques.
Knowledge of program management processes and techniques.

Location

AUSTIN

Work Type

Eligible for Telework
Regular
Full time

Experience Level

Highly advanced
Limited supervision
Considerable latitude for initiative and independent judgment

Education Level

Bachelor's degree

Salary/Compensations

$5,797.66 - $9,508.25 Monthly

Benefits

100% paid employee health insurance for full-time eligible employees
Defined benefit pension plan
Generous time off benefits
Numerous opportunities for career advancement

About the Company

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.
The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services (MCS) department seeks a highly qualified candidate to fill the Program Specialist VII position in Program Enrollment and Support, Premiums Payable System.
MCS is driven by its mission to deliver quality, cost effective services to Texans.

Equal Opportunity

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.
All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position.