Texas Health and Human Services
Overview
Join to apply for the
Case Analyst
role at
Texas Health and Human Services . Location: AUSTIN, TX. The Program Specialist V – Case Analyst is part of the Texas Health and Human Services (HHS) Office of Inspector General (OIG) Chief Counsel Division. The CA performs high-level consultative and technical work under the guidance of the Director of Financial Analysis and Case Management. The role involves reviewing, researching, analyzing, and evaluating case results, investigative findings and payments related to complex cases involving health care provider fraud, waste, and/or abuse in the Medicaid system and other HHS programs. Responsibilities include making recommendations and assisting in processing contract cancellations, exclusions and terminations. The CA interprets policies, procedures, rules, regulations, and standards related to Texas health and human services programs and ensures compliance with federal and state laws and regulations. The CA works under general supervision of the Director or designee, with substantial latitude for initiative and independent judgment. Responsibilities
Assists with the enforcement of assessed final debt amounts, and any associated collection activities (40%). Conducts research pertaining to case results, investigative findings, and payments to make determinations and recommendations concerning contract cancellations, exclusions, terminations and impacted program areas (40%). Handles all case closing processes, including scanning and uploading relevant documents into the case management system and case library and closing completed cases (10%). Prepares monthly and annual reports with supporting tables and documentation for internal and external stakeholders (5%). Performs other duties as assigned and keeps manager informed as required. Knowledge, Skills, And Abilities
Knowledge of state and federal laws related to public health care programs (Medicaid, Medicare). Knowledge of collection processes. Skill in using personal computer software (spreadsheets, databases, word processing). Strong written and oral communication skills. Ability to research facts and law from various databases. Ability to review legal and medical files and distill salient information. Ability to interpret policies, procedures, rules, and regulations. Ability to utilize computers and applicable software programs and perform detailed work accurately and timely. Ability to establish and maintain collaborative working relationships and manage time with limited supervision. Qualifications
Initial Screening Criteria Graduation from a four-year college or university, preferably with major coursework in business or health care administration. Experience in business operations involving health care or law may be substituted on a year-for-year basis for the education requirement. Experience using Microsoft applications – specifically Excel. Preferred
Experience in Texas state government operations and functions. Other Information
The OIG is responsible for preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and abuse in the provision of HHS programs. Potential employees are subject to criminal background checks. Selected applicants must complete a national fingerprint-based background check through TDPS and FBI. Any employment offer is contingent upon available budgeted funds. Salary determined by budget and HHSC HR policy. Active Duty, Military, Reservists, Guardsmen, and Veterans are encouraged to apply if qualified. HHSC provides reasonable accommodation during the hiring process under the Americans with Disabilities Act (ADA). HHSC uses E-Verify. Bring I-9 documentation on first day. This position may be eligible for telework; telework policies apply. Location
Job Location City:
AUSTIN Job Location Address:
4601 W GUADALUPE ST
#J-18808-Ljbffr
Join to apply for the
Case Analyst
role at
Texas Health and Human Services . Location: AUSTIN, TX. The Program Specialist V – Case Analyst is part of the Texas Health and Human Services (HHS) Office of Inspector General (OIG) Chief Counsel Division. The CA performs high-level consultative and technical work under the guidance of the Director of Financial Analysis and Case Management. The role involves reviewing, researching, analyzing, and evaluating case results, investigative findings and payments related to complex cases involving health care provider fraud, waste, and/or abuse in the Medicaid system and other HHS programs. Responsibilities include making recommendations and assisting in processing contract cancellations, exclusions and terminations. The CA interprets policies, procedures, rules, regulations, and standards related to Texas health and human services programs and ensures compliance with federal and state laws and regulations. The CA works under general supervision of the Director or designee, with substantial latitude for initiative and independent judgment. Responsibilities
Assists with the enforcement of assessed final debt amounts, and any associated collection activities (40%). Conducts research pertaining to case results, investigative findings, and payments to make determinations and recommendations concerning contract cancellations, exclusions, terminations and impacted program areas (40%). Handles all case closing processes, including scanning and uploading relevant documents into the case management system and case library and closing completed cases (10%). Prepares monthly and annual reports with supporting tables and documentation for internal and external stakeholders (5%). Performs other duties as assigned and keeps manager informed as required. Knowledge, Skills, And Abilities
Knowledge of state and federal laws related to public health care programs (Medicaid, Medicare). Knowledge of collection processes. Skill in using personal computer software (spreadsheets, databases, word processing). Strong written and oral communication skills. Ability to research facts and law from various databases. Ability to review legal and medical files and distill salient information. Ability to interpret policies, procedures, rules, and regulations. Ability to utilize computers and applicable software programs and perform detailed work accurately and timely. Ability to establish and maintain collaborative working relationships and manage time with limited supervision. Qualifications
Initial Screening Criteria Graduation from a four-year college or university, preferably with major coursework in business or health care administration. Experience in business operations involving health care or law may be substituted on a year-for-year basis for the education requirement. Experience using Microsoft applications – specifically Excel. Preferred
Experience in Texas state government operations and functions. Other Information
The OIG is responsible for preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and abuse in the provision of HHS programs. Potential employees are subject to criminal background checks. Selected applicants must complete a national fingerprint-based background check through TDPS and FBI. Any employment offer is contingent upon available budgeted funds. Salary determined by budget and HHSC HR policy. Active Duty, Military, Reservists, Guardsmen, and Veterans are encouraged to apply if qualified. HHSC provides reasonable accommodation during the hiring process under the Americans with Disabilities Act (ADA). HHSC uses E-Verify. Bring I-9 documentation on first day. This position may be eligible for telework; telework policies apply. Location
Job Location City:
AUSTIN Job Location Address:
4601 W GUADALUPE ST
#J-18808-Ljbffr