Customer Services Rep V
Job description
The Texas Health and Human Services Commission (HHSC) Medicaid & CHIP Services (MCS) department seeks a highly qualified candidate for a Customer Service Representative in the Provider Claims Services (PCS) unit.
This position reports to the PCS Program Supervisor and performs highly advanced customer service work in a call center environment. Work involves contact with Medicaid Long Term Care (LTC) providers, Medicaid recipients, HHSC case workers and eligibility staff regarding filing claims for services and billing issues.
The position researches and analyzes complex data within multiple systems to resolve any issues and ensures claims continue to be processed accordingly. The position interprets section policies and procedures for filing claims for services provided under Hospice, Nursing Homes, Intermediate Care Facilities, and various waiver programs including Home and Community-based Services, Texas Home Living, Deaf Blind Multiple Disabilities, and Community Living Assistance and Support Services.
Responds to inquiries regarding claims processing and billing issues for Medicaid LTC providers, recipients, agency case workers and eligibility staff via emails, reports, correspondence, or hotline. Researches and analyzes data within various automated systems to identify issues with claim processing/billing. Documents information in spreadsheets. (45%)
Enters data, supporting records and actions taken to resolve billing or claims processing issues. Uses multiple systems including Client Assignment and Registration System (CARE), IDD Portal, Service Authorization System Online (SASO), Texas Medicaid and Health Care Partnership (TMHP) Long Term Care Portal, and a call tracking system. (35%)
Provides training to Medicaid providers on how to address or resolve issues in filing/processing claims. (10%)
Interprets section policies and procedures for processing claims and service authorizations for LTC providers. Collaborates with PCS coaches to resolve more complex claims/billing issues or provider concerns. (10%)
Knowledge of standard office practices and administrative procedures.
Knowledge of call center operations.
Skill in the use of standard office equipment and software.
Skill in researching and analyzing data to resolve billing issues.
Skill in using and navigating through computer systems to conduct research.
Ability to create or maintain spreadsheets using Microsoft Excel.
Ability to learn and use specialized software programs.
Ability to learn and apply policies and procedures.
Ability to communicate in a professional and friendly manner with staff and customers.
None required.
Experience working in a call center or customer service-oriented environment.
Preferred experience with Provider Claims Services systems.
Preferred experience in researching and interpreting Medicaid policies and procedures.
1. Your application must be complete and contain all the requested information. Job histories must demonstrate how you meet the initial selection criteria at a minimum. An in-basket exercise will be given during the interview.
2. 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.
3. The selected candidate will receive training on the various LTC provider policies, procedures, and computer systems.
4. This position is eligible for partial telework in accordance with applicable HHSC policies. Some on-site work will be required.
Requisition ID: 547915
There are no direct military occupation(s) that relate to the responsibilities, and registration or licensure requirements for this position. All active duty, reservists, guardsmen, and veterans are encouraged to apply if they meet the qualifications for this position.
Top 10 Tips for Success when Applying to Jobs at HHSC and DSHS
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.
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