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Health & Human Services Comm

Program Specialist I

Health & Human Services Comm, Orange, Texas, United States, 77630


Job Description:The Texas Health and Human Services Commission (HHSC) seeks highly qualified candidate to fill the Children's Health Insurance Health Program (CHIP) Request for Review (RFR) - Program Specialist I position within the Office of Medical and Social Services (MSS), Access & Eligibility Services Field Division, Integrity Support Services (ISS) Appeals and Mitigation (A&M). ISS A&M 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. ****Open to current ACCESS AND ELIGIBILITY (AES) TW employees only ****

Program Specialist I

Performs complex CHIP and CHIP Perinatal case administrative reviews and determines eligibility for retroactive coverage. Work involves resolving complaints, performing routine consultative services, providing technical assistance, facilitating extensive coordination, and problem solving related to CHIP Requests for Review and services. Evaluates adherence to contracts, policies, procedures, guidelines, and implements agency program policies to ensure compliance with Health and Human Services (HHS) program requirements. Work involves assisting with the identification of recurring issues within the agencies or programs, and notifying management with developed recommendations, options, and solutions to improve or address areas of concern. May supervise the work of others. Works under moderate supervision with limited latitude for the use of initiative and independent judgment.

Essential Job Functions:(60%) Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. Researches, analyzes, interprets and applies complex Medicaid/Children's Health Insurance Program (CHIP) policies and procedures when applicants or clients disagree with an adverse action regarding eligibility or when a client requests Retroactive coverage. Completes Requests for Review (RFR) tasks accurately and timely. Provides accurate correspondence after each case review. Follows information security protocol policies and procedures in order to maintain the confidentiality of client records. Maintains and updates case records and associated systems according to established policies and procedures. Documents case record using automated equipment to establish a record for each client.

(20%) Communicates and facilitates verbally or in writing effectively and displays courtesy when interacting with internal or external customers. Effectively and efficiently addresses, investigates and resolves complex CHIP complaints and inquiries, problems, and questions received from internal and external customers regarding CHIP program services. Provides appropriate response through accurate interpretation of rules, regulations, and policies related to CHIP Programs. Facilitates and coordinates within Health and Human Services (HHS) and other agencies to facilitate case resolution after case review actions have been completed. Develops and maintains effective internal and external working relationships with agency staff, representatives, other state agencies, federal agencies, or the public. Determines trends and resolves technical issues as it relates to the delivery of services to CHIP clients.

(20%) Assists the supervisor with unit activities including (but not limited to), completion of case work to include work assigned to other staff, case reading, mentoring, completion of reports and assignments, and monitoring as assigned. Assists with projects related to program initiatives, participate in projects, committees, or workgroups. Performs other duties as assigned and required to maintain the operation of the unit. This position may require travel up to 20% of the time.

Knowledge Skills Abilities:Knowledge of Eligibility programs, requirements, and policies. Knowledge of Health Insurance Portability Accountability Act (HIPPA) and Tax Sensitive information regulations. Knowledge of Medicaid/ Children's Health Insurance Program (CHIP) and CHIP Perinatal program policy. Knowledge of CHIP appeals process. Knowledge of customer relations principles and practices. Knowledge of interviewing techniques to obtain highly personal information, make inquiries, and resolve conflicting statements. Skill in the use of computer and programs such as Microsoft Outlook, Microsoft Excel, Word, and Power Point. Skill in the use of TIERS, State Portal, Maximus Enrollment Broker, and other HHS automated systems. Skill in analyzing, evaluating, and resolving highly complex program and policy issues. Skill in interpreting and applying agency, state, and federal rules, regulations, policies, and procedures. Skill in the use of automated data systems. Skill in providing customer service. Ability to read, understand, and apply a variety of interrelated instructions, such as those found in guidelines, regulations, and policies. Ability to interpret, analyze, and evaluate complex program policy and rules and regulations and make accurate assessments. Ability to interview clients or authorized representatives to gather information to determine eligibility for benefits. Ability to obtain, verify, and calculate income and resources to determine client financial eligibility. Experience documenting case records using automated equipment to form a record for each client. Ability to explain program benefits or requirements to clients. Manages assigned projects. Ability to communicate on a complex level with others effectively both verbally and in writing to provide, exchange, verify information, answer inquiries, address issues, and respond to inquiries or complaints. Ability to gather, assemble, correlate, analyze facts, identify problems, evaluates alternatives, and implement effective solutions to problems. Ability to effectively organize, prioritize, write, proofread, and prepare concise reports. Ability to identify problems, evaluate alternatives. Assist in interpreting policy, training new workers, completing unit reports, responding to client complaints, and acting in the supervisor's absence. Ability to work independently and make independent judgments with limited supervision. Ability to establish and maintain effective working relationships with all levels of staff, internal, and external partners. Ability to work with people under pressure, negotiate among multiple parties, and resolve conflicts. Ability to handle multiple tasks/projects requiring flexibility to meet tight deadlines. Ability establish priorities according to relative importance, set goals, and manage time efficiently. Ability to train others. Willing to travel 20% of the time.

Registration or Licensure Requirements:N/A

Initial Selection Criteria:****Open to current ACCESS AND ELIGIBILITY (AES) TW employees only****

Applicants must meet the following education and experience requirements:Experience:

Two (2) year of customer service experience with public contact which can include retail, call center, clerical, hospitality, banking, receptionist, or similar customer service experience. Experience in an environment interviewing clients and gathering personal information in-person or over the phone is preferred.

Education:High School Diploma or GED equivalent is required. Sixty (60) semester or ninety (90) quarter hours from an accredited college or university is preferred.

Thirty (30) semester or forty- five (45) quarter hours from an accredited college or university may be substituted for one (1) year of required experience. Two years' relevant customer service experience with public contact required which can include retail, call center, clerical, hospitality, banking, receptionist, or similar customer service experience.A minimum of three (3) years' experience as a Texas Works Advisor (TWA) is preferred. Current knowledge in SNAP, Medicaid, CHIP, and/or Medicaid for the Elderly and People with Disabilities (MEPD) policy and procedures is required. Ability to interpret, analyze, and evaluate complex program policy and rules and regulations and make accurate assessments is required. Experience in reading and interpreting CHIP/CHIP-P policy and procedures. Required experience in evaluating case records in relation to agency standards for quality and timeliness. Knowledge of CHIP and CHIP Perinatal program policy preferred. Knowledge and/or experience of the CHIP Request for Review process and procedures is preferred. Knowledge of customer relations principles and practices and the ability to work in a professional customer service environment is required. Knowledge of interviewing techniques to obtain highly personal information, making inquiries, and resolving conflicting statements. Required experience in presenting relevant information concerning program policies and procedures to fellow workers, colleagues, clients, and public in a clear and concise manner. Experience providing mentoring support and assistance to staff is preferred. Ability to work days and hours beyond normal work hours as needed is required. Ability to accept additional work assignments. Ability to organize and prioritize work multiple tasks within tight deadlines. Ability to communicate effectively with internal and external entities orally and in writing. Bilingual (English/Spanish) skills preferred.

Additional Information:****Open to current ACCESS AND ELIGIBILITY (AES) TW employees only ****

Number of positions to be filled: 1.PN# 00057144. Requisition #XXXX.

Position can be located in any HHS office where available space can be secured.

Access and Eligibility Services Field Offices normal hours of operation are from Monday-Friday 8:00 am - 5:00 pm. Employees may be required to work occasional overtime, as required by management, outside of normal hours of operation, which may include weekends.

Successful applicants must be willing to work in a highly stressful and fast pace environment, under constant pressure to meet required deadlines.

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.

HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.

I-9 Form - Click here to download the I-9 form.

In compliance with the Americans with Disabilities Act (ADA), HHS 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.

Requisition ID

MOS Code:Note: There may be no military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position. All active duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information see the Texas State Auditor's Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx.

HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.

I-9 Form - Click here to download the I-9 form.

In compliance with the Americans with Disabilities Act (ADA), HHS 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.

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