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Role Description

Program Enrollment and Support (PES) under the Medicaid CHIP Services Division (MCS) is searching for new team members to join our Program Support Unit (PSU). PSU is responsible for facilitating the STAR Kids Medically Dependent Children Program (MDCP) and STAR+PLUS Home and Community Based Services (HCBS) eligibility and enrollment process for applicants and members. Services under these programs assist managed care members with maintaining their independence in the community.

PSU staff perform moderately complex tasks related to Medicaid managed care Long Term Services and Supports (LTSS). Work involves frequent telephone contact with the general public, members and their families, and staff from external organizations such as Managed Care Organizations (MCOs). PSU staff will also coordinate with various internal HHSC departments such as Managed Care Compliance and Operations (MCCO) and Medicaid for the Elderly and People with Disabilities (MEPD).

Upon successful completion of training, PSU staff will have full knowledge of program operational policies, procedures, and software. Duties include:

• Assisting applicants with the eligibility and enrollment processes for Medicaid waiver programs.
• Approving and denying eligibility for Medicaid waiver programs.
• Providing assistance to members transitioning from a nursing facility to the community.
• Validating and entering waiver eligibility records in authorization systems.
• Notifying members of Medicaid waiver program eligibility.
• Managing fair hearing requests for program denials.
• Transferring members between waiver programs.
• Coordinating the age out process for individuals enrolled in a children’s Medicaid program.

This position requires extensive computer usage, research, and comprehension of program policies and procedures to successfully process cases according to PSU program policy and procedures. Staff work under general supervision with moderate latitude for the use of initiative and independent judgment.

Qualifications

• High School Diploma or GED required.
• Prefer experience with case management.
• Prefer experience in a position requiring time management skills.
• Prefer experience with complex policy interpretation requiring good judgement.

Requirements

• Knowledge of Medicaid waiver programs, policies, procedures, and eligibility processes.
• Knowledge of community and government service delivery systems.
• Knowledge of STAR+PLUS Home and Community Based Services (HCBS) program, Medically Dependent Children Program (MDCP), Intellectual or Developmental Disabilities (IDD) - Long-term Care programs and services.
• Knowledge of various types of computer equipment and software including Outlook, Word, and Excel.
• Knowledge of state software such as Texas Integrated Eligibility Redesign System (TIERS), Service Authorization System Online (SASO) or the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP).
• Skills in communicating effectively orally and in writing.
• Skills in managing stress in high-profile situations while maintaining a professional demeanor.
• Skills in identifying systemic problems and ways to resolve those problems.
• Skills in multi-tasking under pressure.
• Skills in managing a workload to meet goals, objectives and timeframes.
• Skills in customer service.
• Ability to convey instructions and explanations to individuals and key parties, to negotiate available services, and to train others.
• Ability to operate computer equipment and be proficient in the use of Outlook, Excel, Word, as well as the ability to gain a general understanding of various state software programs.
• Ability to identify potential problems and act proactively to prevent the problem.
• Ability to establish priorities according to relative importance and deadlines, set goals and manage time efficiently.
• Ability to interpret complex policy and procedure.
• Ability to gather, assemble, correlate, and analyze facts to devise solutions to problems.
• Ability to develop reports based on research and analysis.
• Ability to perform duties with minimal supervision.
• Ability to understand new or changed information and to effectively relay that information to others.

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.