[Hiring] OIG Provider Enrollment Screening Specialist @Texas Health & Human Services Commission

Role Description

OIG is a dynamic organization that specializes in the prevention, detection, audit, inspection, review, and investigation of fraud, waste, and abuse in the provision and delivery of all state health and human services and enforce state law related to the provision of those services. The Provider Enrollment Integrity Screenings (PEIS) team protects the integrity of the Medicaid System by ensuring the prevention of fraud, waste, and abuse. If you have a dedication to integrity and you want to make a difference, this may be the opportunity for you.

The OIG Provider Enrollment Screening Specialist (Research Specialist III) reports to the Manager of the PEIS team in the Data Reviews division of the Office of Inspector General, performing complex (journey-level) research work within a team environment. The OIG Provider Enrollment Screening Specialist conducts reviews of provider enrollment applications into Medicaid, CHIP, and other state healthcare programs. Conducts state and federally required program integrity screenings (including criminal background checks) for providers seeking to enroll, re-enroll, or revalidate in Medicaid, CHIP, and other state healthcare programs. This position makes enrollment recommendations based on screening results, is responsible for managing their own workload and ensures enrollment recommendations are made within 10 business days, as defined by statute. Escalates information to PEIS leadership for assistance when unclear information is identified. May train others, including coordinating, planning, developing, and monitoring research assignments. May assist with the development and review of policies, procedures, and trainings, and provides feedback regarding PEIS activities. May assist with technical development and testing for systems used to research and complete the review of provider enrollment applications and screenings. Works under limited supervision, with moderate latitude for the use of initiative and independent judgment. Performs related work as assigned.

Qualifications

• Minimum of one (1) year experience enrolling, credentialing, or licensing providers or beneficiaries in Medicaid, CHIP, Medicare, or other state healthcare programs.
• Experience in completing licensing verifications with licensing boards and criminal background checks through the Department of Public Safety (DPS) and/or Accurint, preferred.
• Experience reviewing applications associated with participation in Medicaid, CHIP, and other state healthcare programs.
• Experience interpreting and explaining complex programs policies, procedures, rules, regulations, and/or guidelines preferred.

Requirements

• Knowledge of Texas Medicaid, CHIP, other state healthcare, and Medicare programs.
• Knowledge of federal and state laws and rules related to Texas Medicaid, CHIP, and other state healthcare programs related to provider enrollment program integrity requirements.
• Skilled at conducting research, using a variety of databases and available resources to obtain solid conclusions.
• Skilled in creative problem solving, including accessing needed resources from multiple areas and sources and helping management develop solutions.
• Skilled in customer service, team-building, and collaboration.
• Skilled in effective and professional written and verbal communication.
• Skill in searching databases and analyzing results.
• Skill using software such as Excel, PowerPoint, Access, MSWord.
• Skilled in taking initiative and working independently to meet deadlines.
• Ability to demonstrate flexibility in a changing environment.
• Ability to establish and maintain effective working relationships, set priorities, and manage time efficiently.
• Ability to prepare reports and clearly document policies and procedures.
• Ability to exercise good judgment, efficiently organize information, and effectively solve problems.
• Ability to use and learn software specific to the provider enrollment process.

Benefits

• 100% paid employee health insurance for full-time eligible employees.
• A defined benefit pension plan.
• Generous time off benefits.
• Numerous opportunities for career advancement.