Operations - PEMS Reviewer

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Functional Title: Operations - PEMS Reviewer 
Job Title: Program Specialist III 
Agency: Health & Human Services Comm 
Department: Prov Resol and Admin Appeals 
Posting Number: 11627 
Closing Date: 12/15/2025 
Posting Audience: Internal and External 
Occupational Category: Business and Financial Operations 
Salary Group: TEXAS-B-19 
Salary Range: $4,020.33 - $5,178.00 
Pay Frequency: Monthly
Shift: Day 
Additional Shift:  
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: 701 W 51ST ST 
Other Locations: Austin 
MOS Codes: 16GX,60C0,611X,612X,63G0,641X,712X,86M0,8U000,OS,OSS,PERS,YN,YNS 
 
 
 

Program Specialist III

The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Program Specialist III (PEMS Reviewer) in the Provider Enrolment (PE) unit.

The ideal candidate thrives in an environment that emphasizes teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy.

Under the supervision of the Provider Enrollment Manager, the Program Specialist III will serve as a reviewer for work related to PE program policies and processes in a dynamic and fast-paced environment. Work includes researching and interpreting program policies, procedures, rules, regulations, guidance, and standards as they relate to Medicaid provider enrollment. Primarily reviewing and making determinations in Provider Enrollment Management System (PEMS) for Operations Management (OM) requests. Provides operational and technical assistance to program and PE staff, providers, and State Medicaid contractors. May assist with PE reporting. Assists Operations Analysts and other Operations staff in coordinating between clients, providers, and contractors to make determinations and resolve problems and issues.

Essential Job Functions:

(50%) Performs complex consultative and technical work including research, analysis, and resolution related to provider enrollment and provider issues involving Texas Medicaid. Reviews, researches, analyzes and evaluates PEMS requests, as well as provider issues and makes determinations in conjunction with Federal and Texas Medicaid rules, regulations, policies and procedures.

(25%) Prepares correspondence to health care providers answering account questions and advising of enrollment status.

(15%) Provides coordination between health care providers, contractors, governmental agencies, clients and other parties to resolve state escalated complaints related to providers of Medicaid services.

(5%) Participates in workgroups and formulates process in conjunction with providers, provider associations and the Medicaid claims contractor as necessary.

(5%) May train others. May develop policy and procedure manuals. Assists in

preparing justifications for the implementation of procedural or policy changes. Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned to maintain efficient division and agency operations.

Knowledge Skills Abilities:

Knowledge of the Texas Medicaid program or other state healthcare programs

Knowledge of Medicaid Provider Enrollment preferred

Skill in reviewing documentation for accuracy, completion, and adherence to policies

Skill in coordinating the review and finalization of documents for multiple stakeholders

Skill in the use of computer and related equipment, including the use of Microsoft Office Suite or equivalent to include word processing, spreadsheet, database, or presentation software programs.

Ability to gather, assemble, correlate, and analyze data.

Ability to devise solutions to problems

Ability to identify problems, evaluate alternatives, and participate in the implementation of effective solutions

Ability to communicate effectively orally and in writing

Ability to coordinate with other staff, departments, officials, agencies, organizations, and the public

Ability to exercise judgement and work under general supervision

Registration or Licensure Requirements:

N/A

Initial Selection Criteria:

Experience with Medicaid, Managed Care, Healthcare, or Health Insurance programs.

Experience interpreting, researching, and analyzing policy.

Experience with health and human services policies and procedures is preferred.

Excellent written communications as demonstrated by detail and completeness of information provided on the state application.

Additional Information:

1. Your application must be complete and contain all the requested information. Job histories must demonstrate how you meet the initial selection criteria at a minimum.

2. 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.

3. This position may be eligible for telework in accordance with the HHSC Telework Policies, which includes in-office attendance three days a week. Telework policies are subject to change.

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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.