[Hiring] Program Specialist IV @Texas Health & Human Services Commission

Role Description

The Program Specialist IV position reports to the Preadmission Screening and Resident Review (PASRR) Manager within the Intellectual and Developmental Disability (IDD) Services and PASRR Section. This position performs highly complex senior-level work and is responsible for assisting the manager and the PASRR Specialized Services Lead with reviewing, adjudicating, and authorizing requests for specialized services under the PASRR program.

• Evaluate supporting documentation, apply applicable PASRR policies and rules, and determine whether requests meet requirements for authorization.
• Provide technical assistance and policy clarification to stakeholders and providers on procedures, policies, and rules related to PASRR, with an emphasis on specialized services authorization and related claims or payment issues.
• Identify, communicate, and support resolution of documentation or system issues that may affect service authorizations, claims or payments.
• Work under limited supervision, with moderate latitude for the use of initiative and independent judgment.

Ideal candidates should be comfortable with change, skilled at navigating ambiguity, and capable of quickly pivoting when systems or processes prove ineffective or inefficient.

If you're energized by meaningful work, ready to build sustainable systems that improve lives, and excited to make a difference in the IDD community, we encourage you to apply.

Qualifications

• Graduation from an accredited four-year college or university with major course work in a human services field is required.
• At least 2 years of experience in the IDD services field is preferred.
• Knowledge of reimbursement methodologies, claims processing concepts, and healthcare coding or billing practices related to long-term services and supports is preferred.
• Experience reviewing documentation, analyzing authorization or claims issues, and supporting resolution of complex payment concerns is preferred.
• Experience working at a LIDDA or IDD provider is preferred.

Requirements

• Knowledge of PASRR processes, policies, regulations, and specialized services authorization requirements.
• Knowledge of reimbursement claims processing concepts, and factors that may affect claims payment for authorized services.
• Strong organizational and time management skills to handle workload and deadlines.
• Analytical and problem-solving skills to review service requests, evaluate supporting documentation, and identify authorization or claim-related issues.
• Attention to detail and accuracy.
• Excellent communication skills to provide technical assistance and clarification to various stakeholders.
• Skills in using Microsoft Office products.
• Ability to work independently and collaboratively in a fast-paced environment.
• Ability to communicate effectively both verbally and in writing.
• Ability to gather, assemble, and analyze business requirements.
• Ability to develop and or maintain complex spreadsheets using Microsoft Excel.

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.