Human Service Specialist VII

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: Human Service Specialist VII 
Job Title: Human Services Spec VII 
Agency: Health & Human Services Comm 
Department: KHC Admin 
Posting Number: 7078 
Closing Date: 08/05/2025 
Posting Audience: Internal and External 
Occupational Category: Healthcare Support 
Salary Group: TEXAS-B-17 
Salary Range: $3,581.33 - $4,476.83 
Pay Frequency: Monthly
Shift: Day 
Additional Shift: Days (First) 
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: Austin 
MOS Codes: 42SX,4C0X1 
 
 
 

Brief Job Description:

Responsible for performing eligibility determination functions for the programs administered by Specialty Health (SH), including the Kidney Health Care (KHC) Program, the Children with Special Health Care Needs (CSHCN) Services Program, and the Hemophilia Assistance Program (HAP). May also provide eligiblity support for other SH programs. Responsibilities include determining eligibility, providing technical assistance to internal and external partners for the completion of program eligibility, and maintaining client eligibility status.  Coordinates and verifies client benefits.  Monitors clients to ensure compliance with rules, policies, and procedures.  Makes recommendations for action based on findings.  Responds to inquiries regarding eligibility determination of benefits.  Reports directly to the SH Eligibility Supervisor in the SH Client Services Unit with regard to scope of work and assignments.

Essential Job Functions (EJFs):

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. Determine eligibility for the Specialty Health (SH) programs, including Kidney Health Care (KHC) Program; Children with Special Health Care Needs (CSHCN) Services Program; Hemophilia Assistance Program (HAP); along with eligibility support with other SH programs. 40%

Identify, verify, and validate all third-party insurance coverage’s during the application determination process. Correctly coordinate all third-party benefits in accordance with program rules, policies, and procedures. Submit correct coordination plan to the SH Eligibility Team's Insurance staff and verify that they have coordinated the client benefits correctly and accurately. 25%

Correctly setup approved clients as a vendor in the State Comptroller’s payee system in accordance with program rules, policies, and procedures. Reconcile voucher errors and respond to fiscal inquiries timely and accurately. 15%

Serve as an eligibility subject matter expert to internal and external customers and other stakeholders. Assist all stakeholders in understanding SH eligibility rules and requirements. Offer concise answers and provides easily understandable examples of eligibility and system processes. Attend meetings and conference calls as assigned to provide expertise and stay knowledgeable of current changes to the program by attending trainings and staying knowledgeable with updates to policy and procedure manuals. 15%

Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location. 5%

Knowledge, Skills, Abilities (KSAs):

Knowledge:

Knowledge of community and government service delivery systems; Case management delivery systems; state and federal laws, case guidelines, regulations, and policies; programs which support client populations served by Specialty Health about the evaluation of eligibility; individual needs associated with special health care needs/disabilities and related community welfare resources.

Skills:

Skill in interviewing and communicating with clients, case managers, and social workers for the purpose of conducting individual needs assessments; providing technical assistance to providers, clients, and professional staff; navigating interagency procedures; providing customer service support to clients and providers regarding complex eligibility requirements and benefits.

Ability:

Ability to convey instructions and explanations to clients and interested parties; negotiate available services for our client population; develop and interpret policies and procedures, and to assess compliance; communicate effectively with coworkers, clients, and providers; work effectively as a team member.

Certifications: N/A

Initial Screening Criteria:

Experience reviewing applications and supporting documentation to determine eligibility for client service or social service programs such as Medicaid/Medicare, CHIP, or other public benefit programs;

Experience using various automated computer systems and databases to review and confirm supporting documentation for service program eligibility;

Experience in providing customer service to clients and providers regarding complex eligibility requirements and program benefits. 

Additional Information:

Information on application must clearly state how applicant meets initial selection criteria in the summary of experience section of the application. Resumes will not be accepted in lieu of an application. An incomplete application may not be considered. 

Applicants selected for interview will be required to complete an in-basket exercise.

Agency salary policy, budget and candidate’s qualifications will dictate final salary offer.

Additional consideration may be given to candidates that have experience using current systems such as Phoenix, TIERS, IBIS, SharePoint, CMS Portal, etc.

This position is eligible for telework consistent with HHSC telework policy, which is subject to change. Employees may be required to work in the office three or more days a week.

Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC.

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.