Texas Health and Human Services
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OIG TQ Coordination Specialist
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Texas Health and Human Services Position Overview This position is a Research Specialist III within the Office of Inspector General’s (OIG) Targeted Queries (TQ) team. The mission of OIG is to improve the health, safety, and well-being of Texans by preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and abuse in state health and human services programs. The TQ team conducts retrospective payment reviews of Medicaid and other Texas public health care program providers using advanced algorithms to identify indicators of fraud, waste, or abuse. Key Responsibilities
Conduct research related to potential and identified Medicaid overpayments based on targeted query results in accordance with state and federal laws and applicable HHSC and OIG policies, including research related to provider business entities and enrollment; provider billing and reimbursement; Texas Medicaid policies; managed care organization policies, procedures, and processes; and accounts receivables data and information. Processes and distributes incoming TQ payments and issues refunds accurately and timely, ensuring all transactions are consistently and thoroughly documented. Prepares TQ cases to be transferred to other OIG and HHS teams for collection of outstanding debt. The position is responsible for serving as a liaison with other OIG, HHS, and state agency divisions as appropriate, conducting research to ensure that TQ-related payments are deposited and credited accurately. Ensures that TQ payment receipt processes comply with applicable laws, rules, and policies. (40%) Develops and documents policies and processes related to TQ’s accounts receivables workflow, including promoting continuous improvement in strengthening check and electronic payment receipt processes for the team. Conducts quality assurance reviews of TQ accounts receivables processes. Creates and maintains accurate records of research outcomes and query or case-related information and enters all required information timely and accurately into databases and tracking systems. Prepares, edits, and distributes correspondence, reports, studies, forms, and documents based on research conducted and in support of TQ cases. Reviews data, correspondence, and tracking for quality and accuracy. (20%) Develops, designs, plans, implements, and coordinates studies to validate and test provider compliance with published Medicaid policies, rules, and regulations. Performs advanced research and data analysis techniques to isolate trends and patterns of potential aberrant provider billing activity or schemes. Uses a variety of statistical methodologies to evaluate outcomes. Recommends, establishes, and updates procedures to improve TQ processes and enhance Medicaid program integrity. (20%) Serves as a research consultant to both internal and external stakeholders, providing excellent customer service by responding to inquiries and ad hoc requests expediently, clearly, correctly, and professionally. Effectively communicates challenges and barriers to TQ leadership in a timely manner. (15%) Attends work on a regular and predictable schedule in accordance with agency leave policy. Participates in OIG special projects and other work as assigned to achieve OIG’s mission. Keeps manager informed as required or as necessary. (5%) Qualifications
At least two years of experience working with Microsoft Office suite products, including Outlook, Word, and Excel, is required. At least two years of research and planning experience in healthcare, Medicaid, or other health and human services programs is required. Graduation from an accredited four-year college or university with a degree in public administration, computer science, statistical analysis, research methodology, management, business, or related field is preferred. Experience working with Texas Medicaid managed care programs is preferred. Knowledge, Skills & Abilities (KSAs)
Knowledge of local, state, and federal laws and regulations relevant to Medicaid and other public healthcare programs. Knowledge of data analysis techniques and their application to analytical research. Knowledge of measurement, testing, and evaluation of data. Knowledge of research methods, principles, techniques, and philosophies. Knowledge of systems and procedures used to evaluate project performance. Ability to plan, organize, and coordinate research projects. Ability to retrieve and evaluate research data. Ability to accurately interpret and apply policies and procedures. Ability to implement measurement techniques relevant to a specific research project and validate output for relevance, reliability, and accuracy. Ability to interpret and publish research findings. Ability to communicate effectively, both orally and in writing. Ability to coordinate activities among public, private, and professional groups, express ideas clearly and concisely, address audiences effectively, and exercise judgment in evaluating situations and making decisions. Skill in conducting qualitative and quantitative research. Skill in the use of a computer and the use of statistical and evaluative software, tools, and programs. Skill in the use of Microsoft Outlook, Word, Excel, PowerPoint, and Teams. Skill in researching, developing and writing professional reports and/or presentation material. Skill in problem solving and independent decision making. Skill in setting priorities and monitoring progress toward established goals. Skill in developing and evaluating policies and procedures; assessing risks and developing contingency plans; and making recommendations for program improvement.
Skill in synthesizing complicated and technical information and translating it into understandable and concise documents and presentations. Skill in interpersonal relationships, including the ability to work collaboratively with people under pressure, negotiate among multiple parties, resolve conflicts, and establish and maintain effective working relationships. Additional Information
The OIG is responsible for preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and abuse in the provision of HHS in Medicaid and other HHS programs. Potential employees of OIG are subject to criminal background checks in accordance with the HHS Human Resources policy. Selected applicants must complete a national fingerprint‑based criminal background check through Texas Department of Public Safety (DPS) and Federal Bureau of Investigation (FBI) to determine if they have criminal history record information that constitutes a bar to employment. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual. Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC. Active Duty, Military, Reservists, Guardsmen, And Veterans
Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active‑duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions. ADA Accommodations
In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS 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. Pre-Employment Checks And Work Eligibility
Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks. HHSC uses E‑Verify. You must bring your I‑9 documentation with you on your first day of work. Download the I‑9 Form. Telework Disclaimer
This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.
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OIG TQ Coordination Specialist
role at
Texas Health and Human Services Position Overview This position is a Research Specialist III within the Office of Inspector General’s (OIG) Targeted Queries (TQ) team. The mission of OIG is to improve the health, safety, and well-being of Texans by preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and abuse in state health and human services programs. The TQ team conducts retrospective payment reviews of Medicaid and other Texas public health care program providers using advanced algorithms to identify indicators of fraud, waste, or abuse. Key Responsibilities
Conduct research related to potential and identified Medicaid overpayments based on targeted query results in accordance with state and federal laws and applicable HHSC and OIG policies, including research related to provider business entities and enrollment; provider billing and reimbursement; Texas Medicaid policies; managed care organization policies, procedures, and processes; and accounts receivables data and information. Processes and distributes incoming TQ payments and issues refunds accurately and timely, ensuring all transactions are consistently and thoroughly documented. Prepares TQ cases to be transferred to other OIG and HHS teams for collection of outstanding debt. The position is responsible for serving as a liaison with other OIG, HHS, and state agency divisions as appropriate, conducting research to ensure that TQ-related payments are deposited and credited accurately. Ensures that TQ payment receipt processes comply with applicable laws, rules, and policies. (40%) Develops and documents policies and processes related to TQ’s accounts receivables workflow, including promoting continuous improvement in strengthening check and electronic payment receipt processes for the team. Conducts quality assurance reviews of TQ accounts receivables processes. Creates and maintains accurate records of research outcomes and query or case-related information and enters all required information timely and accurately into databases and tracking systems. Prepares, edits, and distributes correspondence, reports, studies, forms, and documents based on research conducted and in support of TQ cases. Reviews data, correspondence, and tracking for quality and accuracy. (20%) Develops, designs, plans, implements, and coordinates studies to validate and test provider compliance with published Medicaid policies, rules, and regulations. Performs advanced research and data analysis techniques to isolate trends and patterns of potential aberrant provider billing activity or schemes. Uses a variety of statistical methodologies to evaluate outcomes. Recommends, establishes, and updates procedures to improve TQ processes and enhance Medicaid program integrity. (20%) Serves as a research consultant to both internal and external stakeholders, providing excellent customer service by responding to inquiries and ad hoc requests expediently, clearly, correctly, and professionally. Effectively communicates challenges and barriers to TQ leadership in a timely manner. (15%) Attends work on a regular and predictable schedule in accordance with agency leave policy. Participates in OIG special projects and other work as assigned to achieve OIG’s mission. Keeps manager informed as required or as necessary. (5%) Qualifications
At least two years of experience working with Microsoft Office suite products, including Outlook, Word, and Excel, is required. At least two years of research and planning experience in healthcare, Medicaid, or other health and human services programs is required. Graduation from an accredited four-year college or university with a degree in public administration, computer science, statistical analysis, research methodology, management, business, or related field is preferred. Experience working with Texas Medicaid managed care programs is preferred. Knowledge, Skills & Abilities (KSAs)
Knowledge of local, state, and federal laws and regulations relevant to Medicaid and other public healthcare programs. Knowledge of data analysis techniques and their application to analytical research. Knowledge of measurement, testing, and evaluation of data. Knowledge of research methods, principles, techniques, and philosophies. Knowledge of systems and procedures used to evaluate project performance. Ability to plan, organize, and coordinate research projects. Ability to retrieve and evaluate research data. Ability to accurately interpret and apply policies and procedures. Ability to implement measurement techniques relevant to a specific research project and validate output for relevance, reliability, and accuracy. Ability to interpret and publish research findings. Ability to communicate effectively, both orally and in writing. Ability to coordinate activities among public, private, and professional groups, express ideas clearly and concisely, address audiences effectively, and exercise judgment in evaluating situations and making decisions. Skill in conducting qualitative and quantitative research. Skill in the use of a computer and the use of statistical and evaluative software, tools, and programs. Skill in the use of Microsoft Outlook, Word, Excel, PowerPoint, and Teams. Skill in researching, developing and writing professional reports and/or presentation material. Skill in problem solving and independent decision making. Skill in setting priorities and monitoring progress toward established goals. Skill in developing and evaluating policies and procedures; assessing risks and developing contingency plans; and making recommendations for program improvement.
Skill in synthesizing complicated and technical information and translating it into understandable and concise documents and presentations. Skill in interpersonal relationships, including the ability to work collaboratively with people under pressure, negotiate among multiple parties, resolve conflicts, and establish and maintain effective working relationships. Additional Information
The OIG is responsible for preventing, detecting, auditing, inspecting, reviewing, and investigating fraud, waste, and abuse in the provision of HHS in Medicaid and other HHS programs. Potential employees of OIG are subject to criminal background checks in accordance with the HHS Human Resources policy. Selected applicants must complete a national fingerprint‑based criminal background check through Texas Department of Public Safety (DPS) and Federal Bureau of Investigation (FBI) to determine if they have criminal history record information that constitutes a bar to employment. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual. Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC. Active Duty, Military, Reservists, Guardsmen, And Veterans
Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active‑duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions. ADA Accommodations
In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS 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. Pre-Employment Checks And Work Eligibility
Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks. HHSC uses E‑Verify. You must bring your I‑9 documentation with you on your first day of work. Download the I‑9 Form. Telework Disclaimer
This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.
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