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Contract Specialist IV
2 months ago
The Texas Health and Human Services Commission (HHSC) Office of Inspector General (OIG)’s mission is to improve the health, safety, and well-being of Texans through good stewardship of public resources and a focus on core public health functions. OIG is a dynamic organization that specializes in the prevention, detection, and investigation of fraud, waste, and abuse in the provision of all state health and human services, enforcing applicable state and federal regulations. The OIG’s Third Party Recoveries (TPR) division is responsible for promoting federal and state requirements related to ensuring that Medicaid is the payor of last resort. The TPR team’s work consists largely of overseeing the contractors who administer Medicaid claims and perform data matching activities to both prevent and recover overpayments when another (third) party was liable for paying for a client’s service instead of Medicaid.
Under the supervision of the OIG’s Third Party Recoveries (TPR) manager, this position will provide contract management support to OIG TPR. Work involves developing, evaluating, and overseeing a broad range of TPR contracts including Fee-For-Service, Managed Care Organizations and Texas Medicaid & Healthcare Partnership. Work involves research, evaluation, and consultative service work that require specialized knowledge of the Medicaid TPR contracts, programs and policies. Assists the TPR Manager with collaborating with other HHSC divisions that oversee contracts that include TPR scope, including the Medicaid Enterprise Systems (MES) contract suite and the Managed Care Organization (MCO) and Dental Maintenance Organization (DMO) contracts. The position is responsible for coordinating with internal OIG staff, HHS staff, other state and federal agencies, contractors, and external stakeholders to strengthen Medicaid Third Party Liability (TPL) program policy and promote compliance with federal and state TPL rules and regulations.
This position coordinates duties and activities with the TPR Manager and Director, performs advanced research, evaluation, consultative, and technical work requiring highly specialized knowledge in planning, developing, implementing, interpreting, and ensuring compliance with TPL program policy and federal and state rules and regulations. Work involves development and implementation of quality assurance and contract monitoring activities, as well as documenting and reporting on contractor performance. The position directs and coordinates critical data requirements, data analysis, reporting protocols and follow-up related to TPR activities. Additionally, the position is responsible for identifying opportunities to develop and implement TPL program policy changes to decrease Medicaid fraud, waste, and abuse; improve compliance with federal and state TPL rules and regulations; and/or reduce inefficiencies related to TPL activities performed by Medicaid vendors and the MCOs/DMOs. This position is also responsible for knowing and adhering to procurement and contracting policies, rules, and statutes. Participates in other contract management and programmatic activities as assigned. Works under minimal supervision with extensive latitude for the use of initiative and independent judgment.
*** This position is primarily a telework position and may be hired from any geographic area of the state where OIG has an office. ***
Essential Job Functions:
Serves as a subject matter expert for TPR program policies in both fee-for-service and managed care. Develops and evaluates TPR contracts, contract requirements, and TPR-related reports and findings for compliance. Coordinates contract development and amendments for assigned contracts within established protocols. Monitors and tracks contract deliverables. Analyzes reports for trends and TPR program compliance. Maintains accurate contract records and generates and prepares reports for overall contract management, internal and external information requests, and prepares and distributes responses/feedback concerning performance measures and contract deliverables. Facilitates contract termination and closeout, including the review and analysis of all program reports and actions, equipment reconciliation (if applicable), and record disposition according to contract terms. (40%)
Provides advanced technical assistance related to contract management and program performance. Facilitates authorization of funding expenditures and validates and approves contractor invoices. (20%)
Consults and communicates, individually or collectively, with contractors, state staff, community stakeholders, and state and local authorities to identify needs, resolve problems, discuss effectiveness of programs and services, and implement program improvements. (15%)
Develops policies and procedures to ensure accountability and documentation related to program performance measures and contract management. Recommends policy changes and business process enhancements to increase the efficiency and effectiveness of the TPR program. (10%)
Collaborates with applicable stakeholders to identify and resolve contract-related issues. Communicates plans and changes to plans to contractors individually and collectively. Collects information and prepares legislative and/or management responses as directed by leadership. (10%)
Performs other duties, as assigned. Keeps manager informed as required or necessary. (5%)
Knowledge Skills Abilities:
Knowledge of local, state and federal laws and regulations relating to HHS procurement and contracting.
Knowledge of HHSC-PCS procurement requirements, forms, and processes. Knowledge of state and HHS contract management policies, procedures, and tools.
Knowledge of business administration and accounting principles. Knowledge of contract data systems, analysis, and reporting.
Knowledge of systemic process improvement techniques and quality assurance processes.
Skill in the use of computer and related equipment, including the use of Microsoft Office Suite or equivalent software programs.
Skill in managing multiple and competing priorities.
Skill in developing performance requirements and measurement tools.
Skill in working collaboratively and cooperatively with diverse groups.
Skill in problem-solving, independent decision-making, and conflict resolution.
Skill in organizing and presenting information clearly, concisely, and effectively (both orally and in writing).
Skill in the development and delivery of effective resource materials and training.
Skill in performing complex research functions.
Skill at providing excellent customer service.
Skill in communicating effectively, both orally and in writing.
Skill in using MS Office Suite (particularly Word and Excel), Outlook, CAPPS 9.2, SCOR, and other related data systems.
Ability to identify problems, evaluate alternatives, and implement effective solutions. Ability to communicate effectively both orally and in writing.
Ability to coordinate and negotiate effectively with other staff, departments, officials, agencies, organizations, and the public. Ability to prepare concise reports.
Ability to lead workgroups, projects, and meetings. Ability to manage program activities.
