PE Specialist

Location: Austin, TX

Salary Range: $4,523.16 - $5,888.50 per month

Shift: Day | Telework: Eligible for Telework (includes in-office attendance three days a week) | Travel: Up to 5%

About the role

The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate for the Program Specialist V (PE Specialist) position in the Provider Enrollment (PE) unit. The ideal candidate thrives in an environment emphasizing teamwork, excellence, curiosity, critical thinking, and integrity. Under the supervision of the Provider Enrollment Manager, this role acts as a provider enrollment expert, focusing on PE program operations, policies, and workflows in a fast-paced, evolving environment.

Responsibilities

• Research and interpret policies, procedures, rules, regulations, guidance, and standards related to Medicaid provider enrollment daily operations.
• Provide operational and technical assistance to program staff, PE staff, providers, and State Medicaid contractors.
• Prepare, edit, and route communications for providers and managed care organizations.
• Review and make determinations in the Provider Enrollment Management System (PEMS) for Operations Management (OM) requests.
• Identify root causes of processing delays and errors to recommend solutions, including gap coverage or backdated enrollments.
• Offer customer service and assist with monitoring the provider enrollment shared mailbox.
• Conduct thorough research and analysis of complex inquiries and complaints from clients, agency staff, advocates, healthcare providers, the Ombudsman’s office, legislators, and other parties using HHSC/TMHP/E-OPM systems and other resources.
• Act as a liaison among clients, providers, and contractors to resolve issues and make decisions.
• Assist with PE reporting and review the Texas Medicaid Provider Procedures Manual and other documents.
• Serve as backup in PE workgroups and train others.
• Lead and participate in operational projects affecting the unit, coordinating with other program areas with minimal oversight.

Essential Job Functions

• Customer Service Support (25%): Assist the Provider Enrollment unit with PE-related questions and complaints. Work with internal and external stakeholders, including contracted vendors, to research and resolve provider questions and complaints.
• Communications (25%): Respond to legislative and external inquiries. Participate in workgroup meetings. Communicate with industry stakeholder groups such as provider associations and health plan associations. Draft and review guidance and notices to providers with program updates.
• Technical Support (15%): Provide technical assistance to program and PE staff, providers, and State Medicaid contractors. Support updates to PE program manuals when operational changes are needed.
• Research and Analysis (15%): Interpret policies, procedures, rules, regulations, and standards to make recommendations on operational requests.
• Liaison (10%): Assist and represent PE in workgroups and meetings to disseminate information on PE policy and programmatic initiatives. Prepare agendas, facilitate discussions, and maintain effective working relationships with PE representatives.
• Special Projects (10%): Lead and participate in operational projects affecting the unit. Coordinate with other program areas with minimal oversight. Other duties as assigned.

Qualifications

• Graduation from an accredited four-year college or university with major coursework in Social Sciences (Sociology, Psychology, or Social Work), Health Information Management, Business Administration, or Healthcare Administration/Health Services Administration is preferred. Experience and education may be substituted on a year-for-year basis.
• Minimum of 1 year of experience researching and evaluating policies or processes for supporting healthcare operations and administrative functions.
• Minimum of 2 years of experience working in provider/customer service, leading workgroups, projects, and meetings.

Knowledge, Skills, and Abilities

• Knowledge of:
  • The Texas Medicaid program.
  • Customer relations principles and practices.
  • Health and human services programs.
• Skill in:
  • Managing multiple and competing priorities.
  • Researching, developing, analyzing, and evaluating complex program and policy issues.
  • Using computer and related equipment, including Microsoft Office Suite or equivalent (word processing, spreadsheet, database, or presentation software).
• Ability to:
  • Identify problems, evaluate alternatives, and implement effective solutions.
  • Communicate effectively orally and in writing.
  • Coordinate with other staff, departments, officials, agencies, organizations, and the public.
  • Review and interpret rules.
  • Lead workgroups, projects, and meetings.

Benefits

• 100% paid employee health insurance for full-time eligible employees.
• Defined benefit pension plan.
• Generous time off benefits.
• Numerous opportunities for career advancement.