MEPD Advisor II

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Brief Job Description:

The Texas Health and Human Services Commission (HHSC) seeks highly qualified candidates to fill the MEPD Advisor II position within the Office of Medical and Social Services (MSS), Access and Eligibility Services (AES) Eligibility Services Division, Appeals & Mitigation. The MSS is driven by its mission to connect people, services, and supports by helping individuals and families in need of food, medical care, cash assistance and other social services. The ideal candidate will thrive in an environment that emphasizes innovation through new ideas, striving for excellence by taking pride in your work, embracing our differences as a source of strength, accomplishing more through partnership, leading by example, and learning for continuous improvement.


The MEPD Advisor II processes appeal requests and represents the agency during the Fair Hearing Process. Accurately determines eligibility for Medicaid for the Elderly and People with Disabilities (MEPD) programs. Work involves interviewing clients in person or via outbound phone call, documenting information gathered, determining eligibility for benefits, verifying case data, explaining program benefits and requirements. Work involves making outbound calls to verify client information. Reviews eligibility of clients for ongoing services. Job requires detailed oriented individuals with ability to apply complex policies and procedures. May be assigned to special projects as needed.  

Essential Job Functions (EJFs):

Maintains a regular and predictable work schedule.

Processes Fair Hearing requests, testifies during Fair Hearings as a technical authority on eligibility issues, and implements Fair Hearing decisions.

Reviews case records to determine validity and accuracy of eligibility determinations made by local office Advisors.

Conducts case reviews and obtains information by observing and recording findings. Provides guidance to regional staff concerning potential errors made on a case.

Resolves complaints and escalated issues.

Counsels’ clients on social services programs, and other state and federal regulations.

Research policies and collaborates with regional attorneys. Confers with Legal and Policy staff to obtain additional information bearing on hearings.

Coordinates hearing activities, to include notifying key stakeholders of upcoming hearings to ensure that they attend said hearings as a witness.

Interviews clients or authorized representatives via phone or in person to gather information to determine eligibility for benefits.  Processes changes to client status, overpayments, and adjusts or restores benefits. Obtains, verifies, and calculates income and resources to determine client financial eligibility.  Conducts collateral cold calls via conference line to obtain verification of client information.

Documents case records using automated systems to form a record for each client.

Communicates effectively with others (internally or externally) to provide, exchange, or verify information, answer inquiries, address issues, or resolve problems or complaints.

Performs shadowing activities with incoming staff.

Perform other duties as assigned.

Must be able to work occasional overtime, as required by management, outside of normal hours of operation, which may include weekends when called upon. Must be able to work in a highly stressful and fast paced environment, under constant pressure to meet required deadlines, interview service times, standards, and thresholds.  

Knowledge, Skills and Abilities (KSAs):

Knowledge of:

• Interviewing techniques to obtain highly personal information, make inquiries, and resolve conflicting client statements.
• Computer functionality and use of Internet, Microsoft Word, Excel and Outlook.

Skill in:

• Establishing and maintaining effective working relationships, including the ability to work with people under pressure, negotiate among multiple parties, and resolve conflicts.
• Organizing, prioritizing, writing, proofreading, editing, filing, record keeping, and interpersonal communication.
• Communicating effectively both verbally and in writing.

Ability to:

• Perform basic arithmetic functions, including using decimals and computing percentages.
• Maintain effective working relationships with others.
• Actively listen to clients, elicit, relate and evaluate information, and interpret terms.
• Complete work within specified deadlines.
• Read, understand, and apply a variety of interrelated instructions, such as those found in guidelines, regulations, and policies.
• Establish priorities according to relative importance and deadlines, set goals, and manage time efficiently.
• Identify conflicting information provided by the clients or their authorized representatives.
• Operate computer equipment.
• Work in a dynamic fast paced and constant changing environment.
• Perform data entry.
• Work independently and under limited supervision.

Registrations, Licensure Requirements or Certifications:

N/A

Initial Screening Criteria:

High School Diploma or GED equivalent required.

Sixty (60) semester hours from an accredited college or university preferred.

Two (2) years of customer service experience with public contact which can include retail, call center, clerical, hospitality, banking, receptionist, or similar customer service experience.

Twelve (12) months experience as an MEPD Advisor II within the last year.

Experience in Medicaid policy and procedures within the last year.

Experience using manual and/or automated systems to determine eligibility for MEPD Medicaid programs within the last year.  

TIERS and Eligibility Workload Management System (EWMS) experience within the last year preferred.

Prefer experience in social service environment which may include but not limited to interviewing clients, gathering personal information, or making eligibility determinations.

Application indicates the willingness to travel.

Application indicates willingness to work beyond normal work hours of 8:00 AM – 5:00 PM.

Additional Information:

Current and former employee applicants should list each position held separately. For example, MEPD Advisor I job experience should be listed separately from MEPD Advisor II job experience.

This position can be located anywhere within the state of Texas in which there is office availability.

Current employees promoting into this position will be offered a salary that meets Human Resources salary guidelines for promoting employees.

Former employees may be offered a salary above $2953.25 if they have recent MEPD or MEPD eligibility experience. Recent experience includes any experience within one year prior to the application closing date.

Applicants who are not current or former Health and Human Services Commission employees will be offered a salary of $2953.25.

Applicants may not have a history of substantiated fraudulent activity against HHSC or any programs it administers. Applicants who have a non-fraud overpayment with an outstanding balance must agree to repay the overpayment balance as a condition of employment.
 

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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