Contract Specialist IV

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.

Job Description:

The Texas Health and Human Services Commission (HHSC) Office of Inspector General (OIG)’s mission is to improve the health, safety, and well-being of Texans through good stewardship of public resources and a focus on core public health functions. OIG is a dynamic organization that specializes in the prevention, detection, and investigation of fraud, waste, and abuse in the provision of all state health and human services, enforcing applicable state and federal regulations. The OIG’s Third Party Recoveries (TPR) division is responsible for promoting federal and state requirements related to ensuring that Medicaid is the payor of last resort. The TPR team’s work consists largely of overseeing the contractors who administer Medicaid claims and perform data matching activities to both prevent and recover overpayments when another third party was liable for paying for a client’s service instead of Medicaid.

Under the supervision of the OIG’s TPR manager, this position works with minimal supervision to provide highly complex contract management support to OIG TPR. Work involves developing, evaluating, and overseeing a broad range of TPR contracts including Fee-For-Service, Managed Care Organizations and Texas Medicaid & Healthcare Partnership. Work involves research, evaluation, and consultative service work that require specialized knowledge of the Medicaid TPR contracts, programs, and policies. Assists the TPR Manager with collaborating with other HHSC divisions that oversee contracts that include TPR scope, including the Medicaid Enterprise Systems (MES) contract suite and the Managed Care Organization (MCO) and Dental Maintenance Organization (DMO) contracts. The position is responsible for coordinating with internal OIG staff, HHS staff, other state and federal agencies, contractors, and external stakeholders to strengthen Medicaid Third Party Liability (TPL) program policy and promote compliance with federal and state TPL rules and regulations.

This position coordinates duties and activities with the TPR Manager and Director, performs advanced (senior-level) contract management work, research, evaluation, consultative, and technical work requiring highly specialized knowledge in planning, developing, implementing, interpreting, and ensuring compliance with TPL program policy and federal and state rules and regulations. Work involves development and implementation of quality assurance and contract monitoring activities, as well as documenting and reporting on contractor performance. The position directs and coordinates critical data requirements, data analysis, reporting protocols and follow-up related to TPR activities. Additionally, the position is responsible for identifying opportunities to develop and implement TPL program policy changes to decrease Medicaid fraud, waste, and abuse; improve compliance with federal and state TPL rules and regulations; and/or reduce inefficiencies related to TPL activities performed by Medicaid vendors and the MCOs/DMOs. This position is also responsible for knowing and adhering to procurement and contracting policies, rules, and statutes. Participates in other contract management and programmatic activities as assigned. Works under minimal supervision with extensive latitude for the use of initiative and independent judgment.

Essential Job Functions (EJFs):

Serves as a subject matter expert for TPR program policies in both fee-for-service and managed care. Develops and evaluates TPR contracts, contract requirements, and TPR-related reports and findings for compliance. Coordinates contract development and amendments for assigned contracts within established protocols. Monitors and tracks contract deliverables. Analyzes reports for trends and TPR program compliance. Maintains accurate contract records and generates and prepares reports for overall contract management, internal and external information requests, and prepares and distributes responses/feedback concerning performance measures and contract deliverables. Facilitates contract termination and closeout, including the review and analysis of all program reports and actions, equipment reconciliation (if applicable), and record disposition according to contract terms. (40%)

Provides advanced technical assistance related to contract management and program performance. Facilitates authorization of funding expenditures and validates and approves contractor invoices. (20%)

Consults and communicates, individually or collectively, with contractors, state staff, community stakeholders, and state and local authorities to identify needs, resolve problems, discuss effectiveness of programs and services, and implement program improvements. (15%)

Develops policies and procedures to ensure accountability and documentation related to program performance measures and contract management. Recommends policy changes and business process enhancements to increase the efficiency and effectiveness of the TPR program. (10%)

Collaborates with applicable stakeholders to identify and resolve contract-related issues. Communicates plans and changes to plans to contractors individually and collectively. Collects information and prepares legislative and/or management responses as directed by leadership. (10%)

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

Registrations, Licensure Requirements or Certifications:

Certified Texas Contract Manager (CTCM) Certification

Knowledge, Skills, Abilities:

Knowledge of local, state, and federal laws and regulations relating to HHS procurement and contracting.

Knowledge of HHSC-PCS procurement requirements, forms, and processes. Knowledge of state and HHS contract management policies, procedures, and tools.

Knowledge of business administration and accounting principles. Knowledge of contract data systems, analysis, and reporting.

Knowledge of systemic process improvement techniques and quality assurance processes.

Skill in the use of computer and related equipment, including the use of Microsoft Office Suite or equivalent software programs.

Skill in managing multiple and competing priorities.

Skill in developing performance requirements and measurement tools.

Skill in working collaboratively and cooperatively with diverse groups.

Skill in problem-solving, independent decision-making, and conflict resolution.

Skill in organizing and presenting information clearly, concisely, and effectively (both orally and in writing).

Skill in the development and delivery of effective resource materials and training.

Skill in performing complex research functions.

Skill at providing excellent customer service.

Skill in communicating effectively, both orally and in writing.

Skill in using MS Office Suite (particularly Word and Excel), Outlook, CAPPS 9.2, SCOR, and other related data systems.

Skill in using Texas Integrated Eligibility Redesign System (TIERS)

Skill in using Gainwell Pharmacy Claims System

Ability to identify problems, evaluate alternatives, and implement effective solutions. Ability to communicate effectively both orally and in writing.

Ability to coordinate and negotiate effectively with other staff, departments, officials, agencies, organizations, and the public. Ability to prepare concise reports.

Ability to lead workgroups, projects, and meetings. Ability to manage program activities.

Initial Screening Criteria:

A minimum of five years’ experience in contract development, management, or evaluation work.

Experience with Health & Human Services (HHS) programs and contract oversight requirements is strongly preferred.

Experience working with stakeholders and diverse groups preferred.

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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