Program Specialist V

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Functional Title: Program Specialist V 
Job Title: Program Specialist V 
Agency: Health & Human Services Comm 
Department: Pharmacy Benefits Mgmt MMIS 
Posting Number: 11312 
Closing Date: 12/03/2025 
Posting Audience: Internal and External 
Occupational Category: Business and Financial Operations 
Salary Group: TEXAS-B-21 
Salary Range: $4,523.16 - $7,253.83 
Pay Frequency: Monthly
Shift: Day 
Additional Shift:  
Telework:  
Travel: Up to 15% 
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:  
MOS Codes: 16GX,60C0,611X,612X,63G0,641X,712X,86M0,8U000,OS,OSS,PERS,YN,YNS 
 
 
 

The Program Specialist V position is a senior position in the Pharmacy Rebates and Business Analysis (PRBA) section of the Vendor Drug Program (VDP) within Medicaid/CHIP Services (MCS) at Texas Health and Human Services.

The Program Specialist V is responsible for ensuring that the pharmacy claims vendor meets contract requirements for processing pharmacy claims and managed care organizations (MCOs) encounter transactions. This position prioritizes and coordinates projects with VDP vendors and trading partners to implement policy changes within the VDP systems. Analyzes system and program changes, or issues, to provide solutions and coordinate their implementation. Oversee vendor test plans and participate in user acceptance testing. Performs highly complex consultative services and provides senior level technical assistance. Participates in meetings with vendors and trading partners of the VDP. Interprets and explains orally and in writing Medicaid rules, regulations, policies, and procedures related to the VDP automated systems. 

* The position is required to work in the office building per scheduled days and subject to established policies.

The selected candidate should be in the Austin area to meet the “in office” work requirement. *

Essential Job Functions:

(20%) Provides advanced research, analysis, evaluation, and technical assistance work for VDP on pharmacy claims adjudication and MCO encounter transactions. Continuously develops understanding of the systems and the relationships with internal and external trading partners and their systems to provide expertise in troubleshooting issues, assessing impact from policy changes, and coordinating changes with trading partners and other areas of the program. Knowledge of the VDP pharmacy claim and the encounter claim edits. Works with contracted vendors and other state staff to develop requirements for implementing program and policy changes.

(10%) This position must have working knowledge of National Council for Prescription Drug Programs (NCPDP) standards to maintain compliance with CMS. Active involvement with NCPDP ensures the policies of the State are reflected in future standards developed by NCPDP. The analysis and information from the Program Specialist V will enable management to support decision-making. Involves understanding and able to provide direction for updates to the NCPDP Post Adjudication Standard, TMHP Post Adjudication Companion Guide, the Quarterly TMHP/NCPDP External Code List (ECL), and other related documentation. Attend NCPDP task group sessions and the in person at the annual NCPDP conference.  

(10%) Works with HHSC Accounts Receivable and Accounts Payable departments on issues around warrants, quick vouchers, claim payment vouchers, budget codes, and other financial issues for pharmacy providers.

(10%) Leads projects and coordinates with other areas to ensure that policy and program changes are implemented. Validates program and system changes through reviews and testing.

(10%) Troubleshoots issues and develops solutions involving delivery of client services and system functionality to coordinate quick and effective solutions.

(10%) Provides reports for management and trading partners both internal and external using data from VDP and other Texas Medicaid Management Information System (TMMIS) applications.

(10%) Experience with developing processes and procedures.

(10%) Monitors contracted vendors to ensure compliance with quality and performance requirements. Familiar with the VDP system vendor contract to perform contact oversight duties.

(10%) Cross trains with other PRBA staff to serve as back-up. Perform other duties as assigned or needed to maintain and improve unit operations.

Knowledge Skills Abilities:

• Knowledge of the Texas Medicaid/CHIP Vendor Drug Program, its systems and interfaces.
• Ability to interpret and explain complex rules, regulations, and policies.
• Knowledge of National Council for Prescription Drug Programs (NCPDP) standards for pharmacy transactions.
• Ability to lead projects involving multiple programs and IT systems.
• Ability to communicate clearly both verbally and in writing.
• Ability to organize and develop work plans, coordinate administrative assignments and adhere to strict deadlines.
• Ability to perform multiple detailed tasks on tight deadlines with a high degree of accuracy.
• Skill in investigating complaints, recognizing problems, and working with others to facilitate solutions.
• Skill in conducting research, analyzing the results, and preparing documents, reports, and correspondence.
• Skill in using the following tools: Microsoft Word, Excel, PowerPoint, Visio, Project, Access or other software tools.

Registration or Licensure Requirements:

None required. 

Initial Selection Criteria:

• Bachelor’s degree from an accredited college or university. Experience and education may be substituted for one another on a year for year basis.
• Three or more years of experience with Medicaid.
• Experience analyzing program, policy and/or system changes preferred.

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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.