Texas Health and Human Services · 23 hours ago
Program Policy Medicaid Modernization Lead
Austin, TX
Contract
Hybrid
Senior Level
$5,098.66/mo - $8,304.83/mo
5+ years expTexas Health and Human Services Commission (HHSC) is committed to creating a positive impact in the lives of fellow Texans. They are seeking a Program Specialist VI who will serve as the Program Policy Medicaid modernization lead, responsible for streamlining and updating the Medicaid delivery system and serving as a liaison for managed care policy.
Health Care
No H1B
Responsibilities
Coordinates and collaborates with internal and external stakeholders to create and update policies, procedures, contract requirements, administrative rules, business rules, and communications to external stakeholders and contractors
Speak to community and professional groups to coordinate, improve, and stimulate interest in the program(s) and to secure support for program(s)
Serves as liaison for community and professional groups to ensure stakeholder interests are represented in agency projects
Develop project timelines for assigned projects, monitors and reports on progress, and updates timelines as necessary
Coordinates and collaborates with the internal and external stakeholders to schedule standing meetings, respond to policy inquiries, draft reports, update content in public-facing documents and websites, and manage shared mailboxes
Assists in researching and analyzing managed care organizations’ compliance with program policy contractual requirements
Identify and prioritize business needs, ensuring alignment with agency goals
Participates in and helps to facilitate meetings with stakeholders, including managed care organizations, provider associations, people receiving services, and subject matter experts
Collaborates with other areas of MCS and HHSC to plan, develop, implement, monitor, interpret and evaluate Medicaid programs, policies, MCO contract requirements, business rules, administrative rules, waivers, and state plan
Evaluates MCO compliance with program policies and procedures, contract requirements, statutes, and rules and takes corrective action if needed
Plans, monitors, and evaluates MCS implementation of state legislation, federal legislation, and federal rules
Analyzes state legislation, federal legislation, and federal rules to evaluate its impact to MCS and stakeholders, including MCOs, service providers, and members
Establishes, facilitates, and participates in relevant workgroups and committees, including inter-agency workgroups and committees
Coordinates and provides requested training to internal staff and external entities
Prepares high quality written documents such as project updates, reports, PowerPoint presentations, communications to stakeholders and contractors, executive memos, policy and project summaries, legislative reports, administrative rules, waivers, and state plan amendments
Other duties as assigned
Qualification
Required
High school diploma and at least five years of full-time work experience in a health and human services field
Bachelor's degree from an accredited four-year college or university and at least one year of full-time work experience in a health and human services field
Master's degree from an accredited college or university in public health, public administration, public affairs, social work, or closely related field
Experience with medical billing and coding
Knowledge of state and federal Medicaid and CHIP laws and regulations
Knowledge of complex national medical billing and coding requirements, CMS requirements, Medicare and Medicaid billing processes
Knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), National Correct Coding Initiative (NCCI), and International Classification of Diseases (ICD) medical billing and coding systems
Knowledge of government organization and administration
Knowledge of principles of health and human services policy and planning
Knowledge of state of Texas legislative processes
Skills in medical billing and coding
Skills in analyzing, evaluating, and interpreting complex federal and state legislation, program, policy, and operations issues
Skills in project management, policy analysis, and performing policy research
Skills in synthesizing, analyzing, and evaluating highly complicated and technical information
Skills in translating policy and technical information into easily understandable and concise documents and oral presentations
Skills in developing creative and workable solutions to complex problems and policy issues
Skills in facilitating stakeholder and different workgroup meetings
Ability to develop, amend, and interpret program policies, rules, and contract requirements related to Medicaid and CHIP Services
Ability to develop and provide information to support lean business cases for information technology projects
Ability to research, gather, assemble, correlate, and analyze data and devise solutions based on the information available
Ability to work with a team under pressure, negotiate among multiple parties, resolve conflicts
Ability to exercise judgment and work independently with minimal supervision
Ability to work cooperatively as a team member in a fast-paced, deadline-oriented environment
Ability to establish and maintain effective working relationships with various levels of personnel in government entities
Ability to use Microsoft Office Suite applications such as Outlook, Teams, Word, PowerPoint and Excel
Ability to communicate effectively both orally and in writing, including the ability to adjust communications to fit the intended audience
Ability to work with diverse groups of people, including stakeholders, representing diverse perspectives
Preferred
Experience in policy development and analyzing Medicaid policy
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
Company
Texas Health and Human Services
Texas Health and Human Services is an agency that focuses on improving health, safety and well-being.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Dr. Napoleon Broughton
Chief Executive Officer: Life Enhancement Solutions
John F. Palermo
CTO Strategic Analyst VI
Recent News
Help Net Security
2025-04-09
Fort Worth Star-Telegram
2024-04-01
Company data provided by crunchbase