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Program Specialist Iii
3 months ago
Program Specialist III-
- The Fair Hearings Coordinator reports to the Quality Assurance Manager within the Intellectual/Developmental Disabilities Program Eligibility and Support (IDD-PES) and works as a team member to support unit functions.
- The IDD PES team is responsible for ensuring eligible Texans are enrolled in programs serving individuals with intellectual and/or developmental disabilities. These programs include: HCS, TxHmL, Community Living Assistance and Support Services (CLASS), ICF/IID, and Community First Choice Non-Waiver (CFC NW). IDD PES staff authorize and verify programmatic eligibility for the listed programs. In addition, IDD PES staff process enrollments, transfers, suspensions, and terminations for HCS, TxHmL, and CLASS and coordinate and attend Fair Hearings.
- As the Fair Hearings Coordinator, work involves monitoring individuals' Medicaid financial eligibility; coordinating intra-agency entities and staff, Fair Hearing Officers, other external stakeholders, and individuals involved in the IDD Waiver Programs in preparation for Fair Hearings; providing technical assistance and consultation to unit staff and external stakeholders on the Fair Hearing process; running Quality Assurance (QA) reports for the unit and making suggestions to improve accuracy and efficiencies based on QA data; and training and providing guidance to unit staff and IDD Waiver Program providers. Works under general supervision, with moderate latitude for use of initiative and independent judgment.**Essential Job Functions**:
Works collaboratively across MCS to identify innovative and effective solutions. Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
- (35%) The Fair Hearings Coordinator coordinates those involved in each Fair Hearing including the collection, organization, analysis, and preparation of materials in response to requests for Fair Hearings. Those involved in this Fair Hearing process include, but are not limited to, unit staff, intra-agency staff, Fair Hearing officers, external stakeholders, and individuals terminating or being denied Level of Care (LOC) that prevents them from being eligible to receive IDD Waiver Program services.
- (25%) Communicates with external entities to resolve complex cases and addresses inquiries by appropriately interpreting policies and operational standards. Additionally, the Fair Hearings Coordinator trains external entities on Fair Hearings policies and operational procedures. All external presentations are vetted through upper management to ensure the information is accurate and aligned with department and agency goals.
- (20%) Monitors financial eligibility for individuals who receive IDD Waiver program services and communicates loss or pending loss of Medicaid to unit staff in preparation for program termination or continued benefits and associated Fair Hearing documents.
- (10%) Provides consultation and technical assistance to unit staff and management regarding TIERS and Fair Hearing policies and procedures.
- (10%) Implements routine Fair Hearing and QA reporting to direct supervisor and suggests actions to improve accuracy and efficiencies based on QA data. Assists with writing policies and procedures when updates are needed.**Knowledge Skills Abilities**:
Knowledge of long term care and/or other Medicaid services.
- Skills in evaluating program performance and/or process improvements.
- Skilled in organization and prioritization.
- Ability to communicate effectively, both orally and in writing.
- Ability to understand, follow, and train others on policies and procedures.
- Ability to multi-task, be detailed-oriented, and meet all deadlines.-
**Registration or Licensure Requirements**:
None
**Initial Selection Criteria**:
Knowledge of Medicaid services.
- Work experience in providing excellent customer services.
- Work experience coordinating, gathering, and sharing information with management.
- Graduation from an accredited four-year college or university with major course work in a field relevant to the assignment is generally preferred.
- Work experience in Medicaid eligibility within Health and Human Service (HHS) and/or experience with the Texas Integrated Eligibility Redesign System is generally preferred.**Additional Information**:
**MOS Code**:
no codeHHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.
