Medicaid Compliance Specialist

3 weeks ago

Austin, United States Texas Department of Aging & Disability Services Full time
Job Description:
Program Specialist VI – Medicaid Compliance Specialist

This position is hybrid – 1 day in the office and 4 days telework, subject to adjustment based on work needs.

The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) division seeks a highly qualified candidate to fill the position of Medicaid Financial & Compliance Specialist. MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution to MCS’s mission by performing technical review of financial deliverables and performing consultative work within Medicaid CHIP Services (MCS). Key responsibilities and tasks include, ensuring compliance with financial terms of managed care contracts, compiling, reviewing, and analyzing financial deliverables submitted by Managed Care Organizations, preparing reports, responding to inquiries, recommending appropriate action to resolve financial and regulatory problems, and assisting in training others, as needed. This position works under general supervision, with moderate latitude for the use of initiative and independent judgment.

The ideal candidate thrives in an environment that emphasizes teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy.

This position reports to the Director – FSR Reconciliation Team. This position will require working as part of a team and has no supervisory responsibility.

This position is part of the FSR Reconciliation team within Financial Reporting and Audit Coordination (FRAC). FRAC is part of Managed Care within Medicaid CHIP Services (MCS). This position will be responsible for ensuring the compliance of Managed Care Organizations with financial compliance requirements.
Essential Job Functions:
Essential Job Functions:
1. Collects, logs, and reviews Financial Deliverables. (85%)
• Accesses electronic versions of required financial deliverables in Excel, Word or PDF format, from FTP site, Enterprise Portal and/or other HHSC designated secure portal, or via email, as appropriate.
• Downloads financial deliverables to MFRAC’s shared MCO Information folders, and files appropriately. Opens files and reviews thoroughly for complete data, and presence of required compliance elements.
• Logs receipt of deliverables accurately, noting any issues on a separate shared issue tracking log.
• Confirms receipt of financial deliverables to the Managed Care Organizations (MCOs) and Medicare-Medicaid Plans (MMP) via email, addresses any items that require correction or remediation, and follows up via email with requests on submissions which are missing after the due date.
• Drafts emails to MCOs to address financial or compliance issues using standard review language, contract language/references, and appropriate data
• Keeps financial deliverables log(s) up-to-date and accurate.
• Follows up appropriately to obtain necessary compliance documentation.
• Maintains complete & appropriate documentation for audit purposes.
Job functions may evolve or change as may be warranted. Tasks will fluctuate significantly with respect to MCO and MMP contract amendments, leadership mandates, and other aspects and position might be called upon to perform on other as-needed high priority and special projects.

2. Develops and maintains communication with Managed Care Contract and Compliance (MCCO) Specialist teams and MCCO Managers and other internal staff. (15%)
• Provides emails, reports, and supporting data to assist in addressing and resolving Program issues.
• Requests additional data as needed to complete assigned tasks.
• Strives for effective communication in person, via email, in writing or on the phone.
• Represents reconciliation team at meetings and during group discussions.
• Maintains professional correspondence with MCO finance contacts.
• Responds to internal & external stakeholders’ email requests professionally and timely.
• Creates & modifies Outlook Calendars as needed. Knowledge Skills Abilities:
Ability to work collaboratively across MCS to accomplish objectives

A keen attention to detail and the ability to implement creative solutions to problems

Able to balance team and individual responsibilities

Personal Computer skills, particularly MS Excel

Competent and comfortable working in Excel spreadsheets on a daily basis.

Ability to review business contracts written in the English language to find pertinent financial data, and the ability to summarize impactful information within contracts via spreadsheet documentation, emails, reports including appropriate graphics or metrics, and verbal or written executive summaries.

Ability to perform independent research in order to ensure compliance with established procedures, contract requirements, laws and regulations.

Works quickly & accurately with limited supervision to resolve basic or recurring financial compliance issues.

Exercises appropriate professional judgement to request input from the Director – FSR Reconciliation when needed to resolve complex issues.

Takes ownership of work and projects to ensure successful quality completion.

Provides progress updates to internal stakeholders, as appropriate.

Works individually, within a team, department, or cross-departmentally to meet deadlines.

Develops internal policies and procedures.

Ability to review, interpret, and summarize complex information.

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