Conducts reviews to determine compliance with program requirements, rules, laws and/or statutes. Works with program staff in determining trends and resolving technical problems. Responsible for completing sample selection and all other functions necessary for monitoring and review activity. (30%)
Ensures Notification, Refute, Demand for Payment, Payment Plan and any other correspondence or forms is accurate and concise. Provides accurate information to Provider Recoupments and Holds (PRH) in Provider Claims Services, or current recoupment staff, without errors. Communicates effectively with PRH, internal and external stakeholders regarding provider correspondence items (Demand Letters, Payment Plans, etc.) Accurately evaluates providers’ eligibility for payment plans due to overpayments and does not exceed 12 months, fall below 10% average monthly billing, or otherwise disqualify providers from eligibility. (20%)
Provides tracking for all recoupments with aid from Accounts Receivable’s monthly report and HHSC’s provision of tracking, letters, and communication. Established Accounts Receivable claims for incoming payments. (5%)
Assists in preparing justifications for the implementation of procedural or policy changes. Assists in the review of HCS/TxHmL/CLASS/DBMD/CFC/CDS program area functions and operations, in identification of areas of needed changes, and in the development of plans to improve or initiate programs or to address areas of concern. Assists in analyzing the business practices related to billing and develops corrective action plans to be implemented by providers. (10%)
Acts as liaison with consumers, agencies and internal program staff to explain and provide technical assistance on agency and program statutory requirements for HCS/TxHmL/CLASS/DBMD/CFC/CDS. Collaborates on analysis and documentation of HCS/TxHmL/CLASS/DBMD/CFC/CDS program policies. Provides technical assistance and training via telephone and in person to HCS/TxHmL/CLASS/DBMD/CFC/CDS providers regarding the billing requirements and Texas Administrative Code to facilitate compliance with contract requirements. Prepares justifications for procedural changes pertaining to HCS/TxHmL/CLASS/DBMD/CFC/CDS. Prepares administrative reports, studies, and specialized research projects. (10%)
May recommend and coordinate activities to produce a more effective HCS/TxHmL/CLASS/DBMD/CFC/CDS programs. May develop policy and procedure manuals. (10%)
Produces high quality products within timeframes specified by supervisor. Identify and request training appropriate to job functions, as needed. (5%)
Decisions are varied but based on broad principles and guidelines. May train others. Performs related work as assigned. Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. (10%)
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work
In accordance with Texas Government Code, Section 656.003, HHSC is required to include applicable Military Occupational Specialty (MOS) codes from each branch of the U.S. Armed Forces related to employment openings. The following are applicable MOS codes:
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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.