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Program Specialist III
2 months ago
This position is within Program Enrollment Services under the Medicaid/CHIP Services division. In a fast paced, deadline-oriented environment, this position performs programmatic assistance work for the STAR, STAR+PLUS, STAR Kids, STAR Health and dental managed care programs. This position is a hybrid telework position. The ideal candidate for this position possesses the ability to work independently, manage time, organize efficiently, is self-motivated and possesses independent judgement. The ideal candidate for this position is passionate about connecting Medicaid eligible and certified individuals to Texas Medicaid health and dental plans to access covered medical and dental services. This position conducts detailed reviews of individual managed care enrollment members to determine if eligibility requirements are met for enrollment into the appropriate managed care model and to ensure accurate system classifications for premium payments. The ideal candidate also communicates effectively; both verbally and nonverbally. Following established timeframes, this position is responsible for providing timely responses to assigned requests and inquiries. This position is responsible for analyzing managed care data including Medicaid eligibility, Premium Payment, and Encounter data to resolve issues. This position analyzes available data and makes recommendations to ensure the managed care data systems are functioning properly and meeting state and federal reporting needs. This position possesses analytical, problem solving and organizational skills and the ability to conduct research, gather, assemble, correlate, and analyze facts and data, devise solutions to problems. This position identifies operational trends, makes sound suggestions and resolves operational problems in coordination with managed care policy and procedures. This position reviews and analyzes agency generated and ad-hoc reports. This position understands and models organizational values and contributes to the development of teamwork within HHS and the Medicaid CHIP division, as well as other HHS agencies. This position demonstrates commitment to the goals of the Medicaid CHIP division, including showing initiative to take on new projects, being team-oriented and committed to outstanding customer service, with a focus on promoting efficiency and accountability. The ideal candidate attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
Essential Job Functions:
50%) Reviews, analyzes and responds to inquiries made by various sources through the Managed Care Eligibility Enrollment Inbox (MCEE mailbox) regarding Medicaid managed care enrollment using STAR, STAR+PLUS, STAR Kids, STAR Health and dental policies and procedures, including determining if managed care enrollment requirements are met and payment rate classifications are accurate. Able to meet deadlines and provides timely responses. Escalates complex cases and complaints regarding the Medicaid managed care program to appropriate staff. This position identifies operational trends, makes sound suggestions and resolves operational problems in coordination with managed care policy and procedures.
(25%) Reviews, analyzes and responds to agency generated reports using STAR, STAR+PLUS, STAR Kids, STAR Health, and dental policies and procedures; including determining if managed care enrollment requirements are met and payment rate classifications are accurate. This position performs data analysis to verify data integrity and identifies operational trends, makes sound suggestions and resolves operational problems in coordination with managed care policy and procedures.
(20%) Collaborates with the Medicaid and CHIP health plans, HHSC staff, other state agencies and external associations on managed care issues.
(5%) Apprises team lead and supervisor of work-related incidents as situations arise that could be problematic to staff, the department, or the agency. Communication with the team lead and supervisor is timely and current with regard to problematic situations and proper judgment is used to assure action taken is appropriate. Knowledge Skills Abilities:
Ability to work, independently or cooperatively, as a team member in a rapid-paced, deadline-oriented environment. Must have knowledge of Medicaid and CHIP eligibility. Knowledge of Long-Term Service Support (LTSS) programs in the various managed care programs. Knowledge of state and federal laws, regulations and processes regarding Medicaid Managed Care and CHIP enrollment. Skills to work with multiple stakeholders and provide direction to contracted vendors. Analytical and organizational skills and the ability to gather, assemble, correlated, and analyze facts; and devise creative solutions to problems. Skill in using personal computer application software such as Microsoft Word, Power Point, Excel, Microsoft Project or similar programs. Skilled in written and oral communication
