Program Specialist II

Date: May 7, 2025

Location:

AUSTIN, TX

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Functional Title: Program Specialist II	Job Title: Program Specialist II
Agency: Health & Human Services Comm	Department: Hospitals Section
Posting Number: 4961	Closing Date: 06/06/2025
Posting Audience: Internal and External	Occupational Category: Business and Financial Operations
Salary Group: TEXAS-B-18	Salary Range: $3,793.41 - $5,921.25
Shift: Day	Additional Shift: Days (First)
Telework: Not 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: 909 W 45TH ST #634 BLDG 4

Other Locations:

MOS Codes:

16GX,60C0,611X,612X,63G0,641X,712X,86M0,86P0,88A0,88B0,8U000,OS,OSS,PERS,YN,YNS

Job Description:

Program Specialist II provides complex technical assistance and consultative services to facility reimbursement staff located in the state hospitals. Provides oversight of Medicaid, Medicare, third party insurance and other claims activity performed by reimbursement staff. Assists in planning, analyzing, developing, implementing, monitoring, and problem solving for reimbursement programs. Position prepares third party payor credentialing applications, desk audits and resolving AVATAR issues. Provides and participates in cross-training of Reimbursement and Revenue Management staff.

Essential Job Functions:

Provides oversight, assistance and support for maximizing revenues in the reimbursement programs. Provides incident-specific technical advice to field staff and initiates corrective action to resolve billing and payment problems. Conducts program desk audits to evaluate and monitor procedures for reimbursement operations at the state hospitals.
Serves as liaison with Information Technology staff for production control of jobs and with agency accounting staff for monthly billing and payments.
Reviews end-of-month closing operations for Claims system; reviews and analyzes numerous reports and other data to ensure validity; assists with the oversight of production and mail-out of billing statements, and financial reports that are system generated each month.
Develops and monitors complex spreadsheets and other applications as assigned.

Maintains liaison with Medicare, Medicaid and third party insurances fiscal intermediaries, carriers, and other governmental and private entities to ensure successful and appropriate claims processing. As needed, reviews, coordinates and tracks Medicare Part A provider enrollment and Medicaid provider enrollment to ensure information is accurate and up-to -date.

Reviews and disseminates relevant provisions of state and federal regulations, rules of the department, and information from other publications that affect the policies or procedures necessary to obtain reimbursement for services provided.

Actively monitors denied or pending Medicaid eligibility cases and initiates corrective action with appropriate agency on problems as needed. Advises Reimbursement staff on necessary action to obtain eligibility and prevent loss of revenue.
Assists in development of Reimbursement goals and objectives related to state hospitals; develops and recommends program guidelines, procedures, policies and/or rules; assists in setting priorities and program standards for achieving goals and objectives; and assists in evaluating the effectiveness of program activities to achieve maximum reimbursement.
Reviews and assists in planning, analyzing, developing, implementing, monitoring, and problem solving reimbursement programs and automated systems.

Develops, prepares, and provides training and operational/educational materials for various reimbursement programs.

Attends work regularly and meets standards for other duties as assigned by supervisor.

Registrations, Licensure Requirements:

None

Knowledge Skills Abilities:

Experience in various third-party programs such as Medicare, Medicaid, and private health insurance.
Experience in medical claims submission and reconciliation.

Advanced skill in using computer software, including but not limited to Outlook, Word, and Excel.
Skill in effectively managing, reconciling and/or reporting accounts receivables.

Skill in developing and/or implementing complex reporting specifications.

Skill in communicating effectively verbally and in writing.
Ability to learn, interpret, and apply state and federal rules, regulations, policies and procedures.
Ability to perform mathematical computations.

Ability to learn mainframe systems such as Claims2 and CARE.

Ability to establish and maintain effective working relationships with others.

Initial Screening Criteria:

Experience with Medicaid, Medicare and third-party insurance reimbursement preferred.

Experience in account collections and reconciliation procedures preferred.
Experience using Word, MS Outlook, and Excel.

Experience with AVATAR preferred.

High School diploma or equivalent.

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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.