OIG Targeted Query Coordination Specialist

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Functional Title: OIG Targeted Query Coordination Specialist 
Job Title: Research Specialist III 
Agency: Health & Human Services Comm 
Department: Med Svcs - Acute Care Intake 
Posting Number: 8357 
Closing Date: 09/08/2025 
Posting Audience: Internal and External 
Occupational Category: Office and Administrative Support 
Salary Group: TEXAS-B-20 
Salary Range: $4,263.16 - $5,521.16 
Pay Frequency: Monthly
Shift: Day 
Additional Shift: Days (First) 
Telework: Eligible for Telework 
Travel: Up to 10% 
Regular/Temporary: Regular 
Full Time/Part Time: Full time 
FLSA Exempt/Non-Exempt: Nonexempt 
Facility Location:  
Job Location City: AUSTIN 
Job Location Address: 4601 W GUADALUPE ST 
Other Locations: Austin; Bastrop; Elgin; Georgetown; Giddings; Round Rock; San Marcos 
MOS Codes: 0231,0531,4505,4591,8051,8825,8850,15AX,35F,38A,49A,683X,783X,IS,ISS,OSS 
 
 
 

The Office of Inspector General’s (OIG) Targeted Queries (TQ) team is seeking an enthusiastic, motivated, and adaptable team member to serve as the TQ Coordination Specialist – someone who is willing to take initiative to step in and help wherever it is most needed within the TQ team and across the Data Reviews division.

OIG’s mission is to improve the health, safety, and well-being of Texans through good stewardship of public resources, with a focus on core public health functions. OIG is a dynamic organization that specializes in the prevention, detection, audit, inspection, review, and investigation of fraud, waste, and abuse in the provision and delivery of all state health and human services and enforces state law related to the provision of those services. The OIG’s TQ team conducts retrospective payment reviews of Medicaid and other Texas public health care program providers using advanced algorithms that identify indicators of fraud, waste or abuse in data. The TQ model employs replicable data analysis techniques to detect, deter and prevent new and ongoing fraud, waste and abuse patterns, and recover misspent Medicaid funds.

Working under the leadership of the Targeted Queries Manager, the TQ Coordination Specialist will provide both administrative and operational support across for the TQ team. This position will assist other Research Specialists and TQ leadership with case support and research; including but not limited to communicating with managed care entities; following up on case-related correspondence; assisting with facilitating appeal-related correspondence, such as reminders; and conducting provider research prior to and during case initiation.

Additionally, this position will assist with accounts receivables coordination for the TQ team, ensuring that data and documentation related to TQ cases accurately supports recovery and collections processes, that payments received by the TQ team are documented appropriately in tracking systems and databases, that provider refunds are processed correctly and timely, that check and electronic payments are well documented, and preparing cases to be transferred to other OIG and HHS teams for collection of outstanding debt. The position is responsible for serving as a liaison with other OIG, HHS, and state agency divisions as appropriate to ensure that TQ-related payments are deposited and credited accurately. The position is also responsible for developing and documenting policies and processes related to TQ’s accounts receivables workflow, including promoting continuous improvement in strengthening check and electronic payment receipt processes for the team.

The position serves as a staff-level researcher, using independent judgment and exercising moderate latitude to design, conduct, and evaluate research work products. The position may train and assist other Data Reviews staff in the use of computer applications, research methodologies, project development, and in the identification of resources necessary to produce effective outcomes.

The position will perform other duties as assigned. The position requires up to 10% travel with infrequent overnight stays and m. May require work hours other than 8 a.m. to 5 p.m. Requires viewing computer screens for long periods of time, up to six or more hours per day.  

Essential Job Functions:

Conducts research related to potential and identified Medicaid overpayments based on targeted query results in accordance with state and federal laws and applicable HHS and OIG policies, including research related to provider business entities and enrollment; provider billing and reimbursement; Texas Medicaid policies; managed care organization policies, procedures, and processes; and accounts receivables data and information. Processes and distributes incoming TQ payments and issues refunds accurately and timely, ensuring all transactions are consistently and thoroughly documented. Prepares TQ cases to be transferred to other OIG and HHS teams for collection of outstanding debt. The position is responsible for serving as a liaison with other OIG, HHS, and state agency divisions as appropriate, conducting research to ensure that TQ-related payments are deposited and credited accurately. Ensures that TQ payment receipt processes comply with applicable laws, rules, and policies. (40%)

Develops and documents policies and processes related to TQ’s accounts receivables workflow, including promoting continuous improvement in strengthening check and electronic payment receipt processes for the team. Conducts quality assurance reviews of TQ accounts receivables processes.  Creates and maintains accurate records of research outcomes and query or case-related information, and enters all required information timely and accurately into databases and tracking systems. Prepares, edits, and distributes correspondence, reports, studies, forms, and documents based on research conducted and in support of TQ cases. Reviews data, correspondence, and tracking for quality and accuracy. (20%)

Develops, designs, plans, implements, and coordinates studies to validate and test provider compliance with published Medicaid policies, rules, and regulations. Performs advanced research and data analysis techniques to isolate trends and patterns of potential aberrant provider billing activity or schemes. Uses a variety of statistical methodologies to evaluate outcomes. Recommends, establishes, and updates procedures to improve TQ processes and enhance Medicaid program integrity.  (20%)

Serves as a research consultant to both internal and external stakeholders, providing excellent customer service by responding to inquiries and ad hoc requests expediently, clearly, correctly, and professionally. Effectively communicates challenges and barriers to TQ leadership in a timely manner. (15%)

Attends work on a regular and predictable schedule in accordance with agency leave policy. Participates in OIG special projects and other work as assigned to achieve OIG’s mission. Keeps manager informed as required or as necessary. (5%)

Knowledge, Skills and Abilities (KSAs):

• Knowledge of local, state, and federal laws and regulations relevant to Medicaid and other public healthcare programs.
• Knowledge of data analysis techniques and their application to analytical research.
• Knowledge of measurement, testing, and evaluation of data.
• Knowledge of research methods, principles, techniques, and philosophies.
• Knowledge of systems and procedures used to evaluate project performance.
• Ability to plan, organize, and coordinate research projects.
• Ability to retrieve and evaluate research data.
• Ability to accurately interpret and apply policies and procedures.
• Ability to implement measurement techniques relevant to a specific research project and validate output for relevance, reliability, and accuracy.
• Ability to interpret and publish research findings.
• Ability to communicate effectively, both orally and in writing.
• Ability to coordinate activities among public, private, and professional groups, express ideas clearly and concisely, address audiences effectively, and exercise judgment in evaluating situations and making decisions.
• Skill in conducting qualitative and quantitative research.
• Skill in the use of a computer and the use of statistical and evaluative software, tools, and programs.
• Skill in the use of Microsoft Outlook, Word, Excel, PowerPoint, and Teams.
• Skill in researching, developing and writing professional reports and/or presentation material.
• Skill in problem solving and independent decision making.
• Skill in setting priorities and monitoring progress toward established goals.
• Skill in developing and evaluating policies and procedures; assessing risks and developing contingency plans; and making recommendations for program improvement.
• Skill in synthesizing complicated and technical information and translating it into understandable and concise documents and presentations.
• Skill in interpersonal relationships, including the ability to work collaboratively with people under pressure, negotiate among multiple parties, resolve conflicts, and establish and maintain effective working relationships. 

Registrations, Licensure Requirements or Certifications:

N/A

Initial Screening Criteria:

At least two years of research and planning experience in healthcare, Medicaid, or other health and human services programs is required.

At least two years of experience working with Microsoft Office suite products, including Outlook, Word, and Excel is required.

Graduation from an accredited four-year college or university with a degree in public administration, computer science, statistical analysis, research methodology, management, business, or related field is preferred.

Experience working with Texas Medicaid managed care programs is preferred. 

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 Texas Department of Public Safety (DPS) and Federal Bureau of Investigation (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

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.