Research Specialist V

Brief Job Description

The Research Specialist (RS) V reports to the Benefits Management Review (BMR) Manager within the Office of Data, Analytics and Performance (DAP). The position performs highly advanced (senior level) research work. The RS V analyzes Medicaid, Healthy Texas Women (HTW) and Children with Special Healthcare Needs (CSHCN) medical and dental policy and associated claims and encounters. Initiates, plans, coordinates, develops, implements high level research such as fiscal estimates of proposed policy changes, proposed legislation (fiscal notes) and other projects related to Health & Human Services (HHS) that require fiscal impact analysis. As well as supports benefit development and other programs with utilization reviews. The RS V also conducts post implementation utilization reviews (PIURs) and supports HHS with data driven decisions. Supports the Provider Finance Department rate implementation process and the Vendor Drug Program (VDP) with clinician administered drug implementations. The RS V works under minimal supervision, with extensive latitude for the use of initiative and independent judgment. Attends work on regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.

Essential Job Functions (EJFs)

• EJF. 1 (30%) The RS V supports ongoing projects using available information in support of policy and program development under the guidance and supervision of the DAP-BMR Manager. Initiates, plans, coordinates, and participates in research and special projects. Collects or manipulates data related to relevant topics, applies fiscal and budgetary procedures for data analyses using specialized software, spreadsheets and/or databases. Designs and writes reports that include appropriate professional quality. Responsibilities include managing team-based research and special projects to completion, delegating tasks to team members and providing appropriate assistance, evaluation, and feedback to team members.
• EJF. 2 (5%) Works with professionals involved in program and policy development to propose, research, and evaluate policy changes in Medicaid, HTW and CSHCN. Conducts estimated client services fiscal impact analyses for timely implementation of medical and dental benefits. Uses research techniques to study cost trends related to the changing structure and utilization of client services available in Medicaid, HTW and CSHCN. Specific responsibilities include: 1) providing accurate and timely estimates of a fiscal impact for proposed legislation, medical and dental benefit; 2) improving understanding of cost-drivers and budgetary issues related to medical benefit coverage; and 3) providing well-coordinated fiscal impact and fiscal note analysis related to HHSC’s role in rulemaking and the legislative process.
• EJF. 3 (20%) Locates data from existing sources using Business Objects and compiles results for distribution. Provides information on data availability and analytical techniques.
• EJF. 4 (15%) Performs analyses using large and complex databases including Medicaid, HTW and CSHCN, vital statistics, epidemiologic, demographic, and related public health as well as human services data sources. Disseminates results through published reports, presentations, electronic media, and other methods. Analyses are used to support agency wide policy and program initiatives. The position requires interaction with agency and department staff as well as staff of other agencies and organizations. Uses policy and program specific knowledge, financial and data processing to perform these tasks.
• EJF. 5 (10%) Conducts comprehensive study of current research methods and medical and dental benefits. The RS V understands the Medicaid, HTW and CSHCN Programs as well as claims and encounters billing and payment. Critical thinking and presentation skills are pertinent.

Knowledge, Skills and Abilities (KSAs)

• Knowledge of Medicaid, HTW and CSHCN Programs.
• Knowledge of research methods and techniques.
• Knowledge of collecting claims and encounters data.
• Knowledge of claims billing and payment.
• Knowledge of fiscal analysis.
• Ability to gather, correlate and analyze facts.
• Ability to evaluate and interpret policies and procedures.
• Ability to prepare reports.
• Ability to prioritize workload with competing deadlines.
• Possess excellent oral and written communication skills.

Additional Information

• Graduation from an accredited four-year college with major coursework in a related field such as Financing, Accounting, Economics, Public Administration, or a closely related discipline is required. A master’s degree or higher is preferred. Experience in health and human services programs, including data analysis, claims processing, or financial analysis, is preferred. College level education and work experience may substitute for each other, for up to four years.