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About the Role

This position makes a significant contribution to the Medicaid and CHIP Services (MCS) mission by providing oversight to Managed Care Organizations, which deliver covered services across various delivery models, populations, and services. The role involves coordinating the intake, assignment, and resolution of complaints and inquiries, ensuring compliance with contract requirements and laws.

Responsibilities

• Coordinates the intake and assignment of complaints and inquiries from clients, providers, advocates, and legislators about the contracted Medicaid/CHIP health plans.
• Serves as the primary department liaison with clients and providers.
• Reviews, analyzes, and responds to routine inquiries and complaints regarding the Medicaid Managed Care Program.
• Triage, redirects, or escalates complex cases as appropriate.
• Coordinates and maintains complaint and inquiry data.
• Tracks, trends, and reports complaint data.
• Performs other work-related work duties as assigned.

Requirements

• Graduation from an accredited four-year college or university with major course work in a field related to health and human services generally preferred.
• Experience and education may be substituted for one another on a year for year basis.
• Experience in Medicaid, Medicaid Dental and CHIP managed care programs, policies, procedures, contracts and service delivery mechanisms is required.
• Experience with using a personal computer and application software such as Microsoft Word, Excel, Power Point or other similar programs is required.
• Experience in using agency programs; TIERS, HHS Enterprise Portal, TexConnect portal and other similar applications are required.

Skills

• Knowledge of subsidized health insurance, including Medicaid, Medicaid Managed Care, CHIP, MCOs, contracts, policies and/or procedures.
• Knowledge of contract management and compliance principles.
• Analytical and organization skills.
• Ability to conduct investigations.
• Ability to gather, assemble, correlate, and analyze facts and data.
• Ability to devise solutions to problems.
• Knowledge of state and federal laws, regulations and processes regarding Medicaid Managed Care and CHIP.
• Skill in using personal computer application software such as Microsoft Word, Business Objects, Excel, Power Point, or other similar programs.
• Skill in using agency programs such as TIERS, HHS Enterprise Portal, HEARTS, TexConnect and other similar applications.
• Skill in written and oral communication.
• Ability to make public presentations.
• Ability to write technical information in an understandable format.
• Ability to produce sophisticated research and analytical reports.
• Ability to interpret legal documents, including contracts.
• Ability to conduct in-depth investigation of complaints and inquiries.
• Ability to reevaluate and develop policies and procedures.

Location

• AUSTIN
• San Antonio
• Alamo
• Rio Grande City
• San Benito

Work Type

• Full time
• Telework may be available

Experience Level

• Public Health Prevention Specialist III

Education Level

• Graduation from an accredited four-year college or university with major course work in a field related to health and human services generally preferred.

Salary/Compensations

• $3,793.41 - $5,921.25 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 Medicaid and CHIP Services (MCS) department 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.