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About the Role
Program Specialist II provides complex technical assistance and consultative services to facility reimbursement staff located in the state hospitals. This role involves oversight of Medicaid, Medicare, third-party insurance, and other claims activity, as well as assisting in planning, analyzing, developing, implementing, monitoring, and problem-solving for reimbursement programs. The position also handles third-party credentialing applications, assists with desk audits, and resolves reimbursement-related issues.
Responsibilities
- Provides oversight, assistance, and support for maximizing revenues in reimbursement programs.
- Identifies and assists with resolving billing and payment problems.
- Collaborates with state hospital staff to resolve issues with Medicaid, Medicare, or third-party payor claims.
- Initiates corrective action with appropriate agencies on problems as needed.
- Advises Reimbursement staff on necessary actions to obtain eligibility, claims processing, and prevent revenue loss.
- Maintains liaison with Medicare and Medicaid fiscal intermediaries, carriers, and other governmental and private entities.
- Assists with Medicare and Medicaid Provider enrollment.
- Assists in the development of policy, procedures manuals, and special forms.
Requirements
- High school diploma/GED required.
- Experience with third-party credentialing processes and contracts required.
- Experience with various third-party programs such as Medicare, Medicaid, and private health insurance.
- Experience with health-related accounting and collection procedures.
- Experience with medical claims submission and reconciliation.
- Advanced skills in using computer software, including Outlook, Word, and Excel.
- Proficient in effectively managing, reconciling, and/or reporting accounts receivables.
- Proficient in developing and/or implementing complex reporting specifications.
- Ability to communicate effectively verbally and in writing.
- Ability to learn how to interpret and apply state and federal rules, regulations, policies, and procedures.
- Ability to learn Electronic Health Records systems such as Avatar.
- Ability to establish and maintain effective working relationships.
- Experience with third-party payors, Medicaid, and Medicare claims processing preferred.
- Experience liaising with third-party payors to maintain contracts/credentialing preferred.
- Experience with internal desk audits of claim payments and denials preferred.
- Experience with Texas Administrative Codes rules and regulations preferred.
Skills
- Advanced skills in using computer software, including Outlook, Word, and Excel.
- Effective management, reconciliation, and reporting of accounts receivables.
- Development and/or implementation of complex reporting specifications.
- Effective verbal and written communication.
- Ability to interpret and apply state and federal rules, regulations, policies, and procedures.
- Ability to learn Electronic Health Records systems such as Avatar.
- Ability to establish and maintain effective working relationships.
Location
- AUSTIN
Work Type
- Full time
- Telework three days a week
Education Level
- High school diploma/GED
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.
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.