Fair Hearings and Quality Assurance Specialist

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.

Functional Title: Fair Hearings and Quality Assurance Specialist 
Job Title: Program Specialist III 
Agency: Health & Human Services Comm 
Department: IDD Prog Eligibility and Spprt 
Posting Number: 11162 
Closing Date: 12/05/2025 
Posting Audience: Internal and External 
Occupational Category: Community and Social Services 
Salary Group: TEXAS-B-19 
Salary Range: $4,020.33 - $6,335.66 
Pay Frequency: Monthly
Shift: Day 
Additional Shift:  
Telework:  
Travel: Up to 5% 
Regular/Temporary: Regular 
Full Time/Part Time: Full time 
FLSA Exempt/Non-Exempt: Nonexempt 
Facility Location:  
Job Location City: AUSTIN 
Job Location Address: 701 W 51ST ST 
Other Locations:  
MOS Codes: 16GX,60C0,611X,612X,63G0,641X,712X,86M0,8U000,OS,OSS,PERS,YN,YNS 
 
 
 

Medicaid and CHIP Services (MCS) at the Texas Health and Human Services Commission (HHSC) seeks a highly qualified candidate to fill the position of Program Specialist III. MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution to MCS’s mission by providing moderately complex consultative and technical assistance for the Intellectual and Developmental Disabilities Program Eligibility and Support (IDD PES) unit. The Program Specialist III reports to the Unit Manager within IDD PES.

The IDD PES team is responsible for ensuring eligible Texans are enrolled in programs serving individuals with intellectual and/or developmental disabilities. These programs include Home and Community-based Services (HCS), Texas Home Living (TxHmL), Community Living Assistance and Support Services (CLASS), the Intermediate Care Facilities for Individuals with Intellectual Disability or Related Condition (ICF/IID), and Community First Choice Non-Waiver (CFC NW). IDD PES staff authorize and verify programmatic eligibility for the listed programs. In addition, IDD PES staff process enrollments, transfers, suspensions, and terminations for HCS, TxHmL, and CLASS and coordinate and attend Fair Hearings.

Under supervision of the Manager of Fair Hearings and Quality Assurance (QA/FH) in the Medicaid CHIP Services (MCS) Intellectual and Developmental Disability, Program Eligibility and Support (IDD PES) unit of the Health and Human Service Commission (HHSC), the Program Specialist III provides Fair Hearings support to unit staff and associated quality assurance data requests to direct supervisor. Work involves monitoring fair hearings and Medicaid eligibility inquiries and ensuring timely resolutions. Work involves developing recurring financial eligibility reports and other reporting duties as assigned. Collecting, organizing, and preparing materials for distribution in response to fair hearings. Assisting with the preparation of training materials including program rules, policy and procedure information to be shared with internal and/or external stakeholders. Working under general supervision with moderate latitude for the use of initiative and independent judgment.

Essential Job Functions: 

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.

(35%) Supports those involved in Fair Hearings (FH) including unit staff, intra-agency staff, fair hearings officers, external stakeholders, and individuals terminating or being denied level of care (LOC) that prevents them from being eligible to receive IDD waiver program services 

(25%) Monitor inquiries and provide technical assistance to internal and external stakeholders regarding fair hearings policies and procedures to resolve complex cases and address inquiries.

(20%) Develop recurring reports regarding financial eligibility for individuals who receive IDD Waiver program services and communicate loss or pending loss of Medicaid to unit staff in preparation for program termination.

(15%) Assist with implementation of routine quality assurance reporting and identify patterns in data to direct supervisor to support actions to improve accuracy and efficiency based on data. 

(5%) Assist with updates of policies and procedures and assist as needed.

Registrations, Licensure Requirements or Certifications:  None   

Knowledge, Skills, and Abilities

Skill in operating computers and applicable software

• Knowledge of Medicaid wavier programs (such as CLASS, DBMD, HCS, TxHmL, or ICF/IID).
• Knowledge of federal and state laws relating to long term care and/or other Medicaid and non-Medicaid services and programs.
• Knowledge of program planning, evaluation, and implementation.
• Skilled in organization and prioritization.
• Ability to communicate effectively, both orally and in writing.
• Ability to understand and follow policies and procedures.
• Ability to maintain accurate files, records, and databases.
• Ability to gather, assemble, correlate, and analyze information.
• Ability to operate computers and experience using Microsoft Office and Adobe products.

Initial Screening Criteria:

• Work experience within a Medicaid program (such as CLASS, DBMD, HCS, TxHmL, or ICF/IID) preferred 
• Experience working with the IDD Operations Portal, Long Term Care Online Portal (LTCOP) and Texas Integrated Eligibility Redesign (TIERS) systems preferred.
• Experience using Microsoft Office and Adobe products.

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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

Telework Disclaimer:

This position may be eligible for telework.  Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.