Program Specialist I

Program Specialist I - The Claims Management System (CMS) Coordinator monitors, researches, analyzes, corrects and/or coordinates the correction of Service Authorization System (SASO), Long Term Care (LTC) Provider System and Texas Integrated Eligibility Redesign System (TIERS) records.

• Maintains information for all LTC Claims Management System (CMS) problems, issues and corresponding resolutions.

• Serves as a contact for State Office staff, regional staff, contractors, and third-party billers.

• Identifies training needs and serves as a resource for staff development.

• Provides training to staff in multiple areas related to program services, systems and policy.

• Performs complex consultative and technical work in planning, developing, and implementing agency programs and/or processes.

• Provides consultative and technical services to agency staff, other governmental agencies, community organizations, contractors, and the public.

• Troubleshoots, researches, and reports SASO, LTC Provider Administration System (LTC Provider), Provider Support Windows (PSWin), Community Services Interest List (CSIL) and SharePoint system defects or unavailability.

• Actively participates with other regional CMS Coordinators in sharing information and seeking solutions.

• Serves as regional CSIL liaison.

• Maintains CSIL database integrity, processes interest list releases, and provides statistical and analytical reports.

• Maintains and monitors other regional databases.

• Administers, develops and monitors multiple regional SharePoint sites as well as other databases.

• Monitors and prioritizes the work of others to ensure timely and appropriate program services are delivered.

• Works under limited supervision with moderate latitude for use of initiative and independent judgement.

• Provides outstanding customer service.

Essential Job Functions:

• Communicates on a complex level with others (internally or externally) to provide, exchange, or verify information, answer inquiries, address issues, or resolve problems or complaints.

• Researches, analyzes, corrects (or coordinates correction) of multiple systems to ensure appropriate and accurate payments, denials and returned claims.

• Prepares reports and analyzes information from multiple systems.

• Develops, maintains and monitors multiple databases to determine trends, issues, developmental strategies and identify training needs.

• Researches and analyzes data to ensure staffing and caseload data integrity.

• Provides training to staff (and community partners).

• Provides consultative and technical assistance to staff (and community partners).

• Administers, develops and monitors multiple regional SharePoint sites as well as other databases.

• Maintains CSIL database integrity, processes interest list releases, and provides statistical and analytical reports.

• Maintains and monitors other regional databases

• Develops and maintains effective working relationships with management, staff, community partners, other state agencies, contractors and others.

• Attends work on a regular and predictable schedule in accordance with agency leave policies, adheres to agency work rules and policies, and performs other duties as assigned.

Knowledge Skills Abilities:

• Knowledge of local, state and federal laws and policies relating to community services to the aged and/or disabled.

• Current knowledge of Community Care Services (CCS) programs and the policies and procedures related to these programs.

• Ability to organize workload and establish priorities according to relative importance and deadlines, set goals, and manage time efficiently in a fast-paced environment while ensuring required time frames are met.

• Skill and ability to devise effective solutions to problems and develop appropriate corrective action plans.

• Ability to develop measurable performance standards and develop appropriate tools to monitor such standards to ensure expectations are met.

• Ability to effectively communicate complex information orally and in writing to varied audiences to resolve problems, provide and exchange information, respond to inquiries, improve program effectiveness and participate in group and/or community presentations.

• Skill in communicating difficult or unpopular information in a positive and motivating manner.

• Ability to develop and maintain effective working relationships with management, staff, community partners, other state agencies, federal agencies, and others.

• Ability to analyze highly complex information and make sound conclusions and decisions.

• Skill with software applications such as SASO, Scheduler, TIERS, Cognos, CSIL, CCRS, and NTK.

• Skill and ability working with Microsoft products such as Outlook, Excel, and PowerPoint.

• Skill working in SharePoint.

Registration or Licensure Requirements:

Must have current valid driver's license. Initial Selection Criteria:

• Applicant has current or recent (within two years) experience as a Community Care Services (CCS) Supervisor or Administrative Worker IV preferred.

• Employment application reflects a job history which includes the use of SASO, , TIERS, CSIL, and SharePoint.

• Employment application illustrates effective written communication skills.

• Must be willing to travel up to 35% of the time.

Additional Information:

• This position is open only to current or past CCSE employees in Region 11*

This position is located at 2520 S. Veterans Blvd., Edinburg, but could potentially be located in any Region 11 CCSE Office where space is available.

Must be able to attend training which may require overnight stay. • Must be able to travel up to 35% of the time (to include overnight stay). • Must be able to work overtime as needed. • Position is located at 2520 S. Veterans Blvd, Edinburg, TX 78539. • Position does not currently allow for telework schedule.

MOS Code:

There are no direct military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position. All active duty, reservists, guardsmen, and veterans are encouraged to apply. For more information see the Texas State Auditor's Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx

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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