Case Analyst

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.

Brief Job Description:

The Program Specialist V – Case Analyst (CA) is part of the Texas Health and Human Services (HHS) Office of Inspector General (OIG) Chief Counsel Division. The CA performs highly advanced (senior-level) consultative and technical work. The duties of this position involve reviewing, researching, analyzing, and evaluating case results, investigative findings and payments related to complex cases involving health care provider fraud, waste and/or abuse in the Medicaid system as well as other Texas Health and Human Service programs. Responsibilities include assisting with allocating, transmitting, monitoring, and tracking Medicaid payments received by HHS OIG and making recommendations and assisting in processing contract cancellations, exclusions and terminations. The CA interprets policies, procedures, rules, regulations, and standards related to Texas health and human services programs and must ensure compliance with federal and state laws and regulations. Under the guidance of the Director of Financial Analysis and Case Management, the CA engages in assisting with the enforcement of assessed final debt amounts, and any associated collection activities. The CA works under general supervision of the Director of Financial Analysis and Case Management or his/her designee. The CA works under limited supervision, with considerable latitude for the use of initiative and independent judgment. This a part time position at 20 hours per week.

Essential Job Functions:

Allocates, transmits, monitors, processes and tracks Medicaid payments received by the OIG, under the guidance of the Director FACM. 15%

Conducts research pertaining to case results, investigative findings, and payments to make determinations and recommendations concerning contract cancellations, exclusions, terminations and or impacted program areas. 50%

Assists with and serves as backup for all accounts receivables set up, adjustments, and monitoring for Medicaid overpayments and court-ordered restitution payments. 15%

Processes and posts payments in the OIG’s case management system and upon receipt of final payment, handles all case closing processes to include scanning and uploading relevant documents into the case management system and case library, and closing completed cases.  10%

Prepares monthly and annual reports with supporting tables and documentation for use by internal and external stakeholders. 5%

Performs other duties as assigned. Keeps manager informed as required or as necessary. 5%

Knowledge, Skills, and Abilities:

Knowledge of state and federal laws related to the public health care programs such as Medicaid and Medicare.

Knowledge of accounting processes.

Skill in use of personal computer, computer software, includes spreadsheet, database, and word processing applications.

Skill in communicating effectively in writing and orally.

Ability to research facts and law from a variety of databases.

Ability to review legal and medical files and distill salient information.

Ability to interpret policies, procedures, rules, regulations, and standards.

Ability to utilize computers and applicable software programs.

Ability to perform detailed work with a high degree of accuracy and in a timely manner.

Ability to establish and maintain collegial and collaborative working relationships with co-workers, agency staff, and management to achieve common goals.

Ability to manage work time efficiently to complete assignments within in a timely manner with limited supervision. 

Registrations, Licensure Requirements or Certifications:

None.

Initial Screening Criteria:

Graduation from a four-year college or university, preferably with major course work in business or health care administration.

Experience in a field related to business operations involving heath care or law may be substituted for the education requirement on a year for year basis.

Experience using Microsoft applications – specifically Excel.

Preferred:

Experience in/with Texas state government structure and functioning.

Additional Information:

The OIG is responsible for preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and abuse in the provision of HHS in Medicaid and other HHS programs. Potential employees of OIG are subject to criminal background checks in accordance with the HHS Human Resources policy. Selected applicants must complete a national fingerprint-based criminal background check through the Texas Department of Public Safety (TDPS) and Federal Bureau of Investigations (FBI) to determine if they have criminal history record information that constitutes a bar to employment.

Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual.

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form