Contract Specialist III

The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Contract Specialist

III. MCS is driven by its mission to deliver quality, cost- effective services to Texans.

The Contract Specialist III within the Contract Administration and Provider Monitoring (CAPM) Unit conducts compliance and fiscal contract monitoring for Medicaid Waiver Programs. Examples of these programs include but are not limited to the Community Living Assistance and Support Services (CLASS) and Deaf-Blind with Multiple Disabilities (DBMD) Medicaid Waiver Programs, and other monitoring reviews such Home and Community Based Services (HCS), Texas Home Living (TXHML), Consumer Directed Services (CDS) and Community First Choice (CFC). This position performs complex (journey-level) consultative and technical assistance services to HHSC program and contract management staff, program providers, contractors, consumers, family members and guardians, and advocates. This position is responsible for conducting, coordinating, and leading both onsite and desk reviews to establish compliance with HHSC rules, billing requirements, and policies and procedures related to billing, contract, and fiscal monitoring.

These reviews require an examination of pertinent authorization and billing documentation, accurately summarizing the findings, and developing and organizing detailed reports of the claims or standards found in error. The Contract Specialist III assists in analyzing the business practices and develops corrective action plans to be implemented by the providers. This position is responsible for assisting in the development and refinement of policy issues involving Medicaid billing, providing technical assistance and training to providers regarding routine and moderately complex Medicaid issues, and maintaining communication and consultation with providers of HHSC and Medicaid programs.

The position assists legal services in defending the actions taken by HHSC during administrative hearings. Completion of work requires initiating and implementing new methods and/or techniques for monitoring activity or reviews. Works under general supervision, with moderate latitude for the use of initiative and independent judgment. May train others. 50% travel required.

Essential Job Functions:

Works collaboratively across MCS to identify innovative and effective solutions for clients and staff. Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.

All employees hired under this job posting are required to work the hours of 8AM to 5PM for the first six months of employment. Supervisors may consider alternate work schedules after the first six months of employment based on performance, responsibility, and the needs of the team.

However, alternate work schedules are not guaranteed.

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%)

Knowledge Skills Abilities:

Ability to work collaboratively across MCS to accomplish objectives; have a keen attention to detail and the ability to implement creative solutions to problems; able to balance team and individual responsibilities; knowledge of public administration and management techniques; and of program management processes and techniques; knowledge of state and federal laws, rules, regulations, policy and procedures relevant to contracts; ability to gather, assemble, correlate, and analyze facts; to establish goals and objectives; ability to make decisions and devise solutions to problems and to provide leadership and staff advice; ability to express oneself clearly orally and to write or compile concise strategic or operational reports, legislative reports, studies and presentations, as needed; ability to write and evaluate procedures; ability to support the work of others; ability to work with diverse groups, stakeholders, agency departments and leaders; skills in formulating written communication for various audiences; skills in managing cross-organizational projects; skills in managing competing priorities using personal computing devices; ability to evaluate fiscal data for reasonableness, necessity, and conformity with contract/rule requirements; skills in operating a computer and operating applicable software, specifically Excel. Ability to travel 50% with overnight stays. Registration or Licensure Requirements:

To maintain employment as a Contract Specialist, this position will require an applicant to obtain specialized certification as a Certified Texas Contract Manager (CTCM). If not currently a CTCM, the selected candidate must obtain CTCM certification within 12 months of hire date unless otherwise approved by supervisor and maintain certification throughout employment. A valid driver's license is required in order to perform the responsibilities of this position. Initial Selection Criteria:

Graduation from an accredited four-year college or university with major course work in business, finance, legal, criminal justice, or a human services related field, plus 2 years of work experience conducting fiscal monitoring, surveys, auditing, reviews or other types of relevant oversight activities or case management. Or a high school diploma with four years of experience conducting compliance or fiscal monitoring in Medicaid Waiver/Social Service/Healthcare Programs or four years of professional work experience involving case management and contract oversight for individuals with intellectual or developmental disabilities.

Experience with interpretation of guidelines, handbooks, laws, rules, policies, and/or statutes. Intermediate skill level using MS Excel, Word, and PowerPoint. Additional Information:

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.

HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work

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.

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:

MOS Code:

Army Enlisted 51C; Army Officer 51C; Navy Enlisted LS; Navy Officer 310X, 651X, 751X, ; Coast Guard Enlisted 420, SK; Coast Guard Officer 020, 28, 35, F&S, FIN10, MGT16; Marine Corps Enlisted 3044; Marine Corps Officer 3006; Air Force Enlisted 6C0X1; Air Force Officer 64PX

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.

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