Program Specialist - Revenue Management

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.

Brief Job Description:

Provides complex technical assistance and consultative services to facility reimbursement staff located in the  13 ICF/IDD  State Supported Living Centers, as well as state-operated community facilities.  Assists in planning, analyzing, developing, implementing, monitoring, and problem solving for multiple third party and non-third party reimbursement programs and automated systems. Medicare B billing support. Manages request and maintains all TMHP authorizations (high end radiological procedures),  Provides support for use of mainframe and software applications for all new hires, and generates reports and data including, but not limited to hospice, legal referrals, etc.   Provides training to facility reimbursement staff and provides and/or participates in cross-training of Reimbursement Management Unit staff.  Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.

Essential Job Functions:
 

 1.  Reviews and assists in planning, analyzing, developing, implementing, monitoring, and problem solving reimbursement programs and automated systems.  (20%)

 2.  Conducts on-site visits or program desk audits to evaluate and monitor procedures for reimbursement operations at ICF-MR state school facilities.  (10%)

 3.  Assists in development of MR Reimbursement goals and objectives related to ICF-MR state schools; 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.  (5%)

 4.  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.  (5%)

 5.  Develops, prepares, and provides training and operational/educational materials for various reimbursement programs.  (5%)

 6.  Maintains liaison with Medicare and Medicaid fiscal intermediaries, carriers, and other governmental and private entities to ensure successful and appropriate claims processing.  (5%)

 7.  Provides oversight, assistance and support for maximizing revenues in the reimbursement programs; and identifies and assists with resolving billing and payment problems.  (25%) 

 8.  Assists with the development of policy, procedures manual, and special forms.  (10%)

9.  Serves as liaison with agency Information Technology staff for production control of jobs and with agency accounting staff for monthly ICF-MR billing and payments.  (5%)

10.  Reviews and approves 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 automated monthly billing statements, the automated ICF-MR Medicaid bill and payment, Claims2 jobs, and production and mail-out of property and financial statements.  (10%)

Knowledge, Skills and Abilities:

Considerable experience with automated or billing systems

Considerable experience effectively managing, reconciling or reporting accounts receivables.

Considerable experience in the use of common business software applications (e.g. MS Word, MS Excel) for personal computers in a stand-alone or networked environment. 

Considerable experience in developing or implementing complex administrative or technical policies and procedures.

Considerable experience in developing or implementing complex reporting specifications.

Ability to devise solutions to problems.

Ability to train others.

Ability to analyze system-generated data and provide guidance on account review and maintenance functions.

Ability to lead programming project development and organize such efforts effectively.

Ability to establish and maintain effective working relationships with others.

Licensure, Certification or Registration:
N/A

Initial Selection Criteria:

Experience with automated or billing systems

Experience with reconciling or reporting accounts receivables.

Experience with federal and state laws and regulations and HHSC rules, policies and procedures affecting third-party and non-third-party reimbursement for services.

Experience with various third-party programs such as Medicare, Medicaid, and private health insurance. 

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.

Nearest Major Market: Austin

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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.