Description
Program Specialist III
Enrollment Resolution Services
This position is within Program Enrollment Services under the Medicaid/CHIP Services division.
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 is a hybrid telework position and requires one in-office day per week. The position may be filled outside of the Austin area and can be housed in HHSC offices throughout the regions, depending on office availability.
In a fast paced, deadline-oriented environment, the ideal candidate performs programmatic assistance work for managed care programs: STAR, STAR+PLUS, STAR Kids, STAR Health and dental.
The ideal candidate for this position possesses the ability to work independently, manage time, organize efficiently, is self-motivated and possesses independent judgement.
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 must possess the ability to read, interpret and apply complex policy and procedures.
The ideal candidate must possess excellent written and verbal communication skills.
Following established timeframes, the ideal candidate is responsible for providing timely responses to assigned requests for reviews.
The ideal candidate is responsible for analyzing managed care data including Medicaid eligibility, Premium Payments, and encounter data to resolve issues.
The ideal candidate analyzes available data and makes recommendations to ensure the managed care data systems are functioning properly and meeting state and federal reporting needs.
The ideal candidate possesses critical-thinking, analytical, problem solving and organizational skills and the ability to conduct research, gather, assemble, correlate, and analyze facts and data, devise solutions to problems.
The ideal candidate identifies operational trends, makes sound suggestions, and resolves operational problems in coordination with managed care policy and procedures.
The ideal candidate 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.
The ideal candidate demonstrates a 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.
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