Program Specialist IV - TPL Policy Analyst
The Office of Inspector General Third Party Liability (OIG-TPL) Policy Analyst is selected by and reports to the TPL Manager and the Director for Technology Analysis, Development & Support. The Policy Analyst provides advanced consultative and technical assistance work requiring specialized knowledge of Medicaid Third Party Liability (TPL) programs and policies. Work involves researching, analyzing, developing, and evaluating Medicaid TPL policies. This position is responsible for leading and participating in workgroups and vendor meetings regarding Medicaid TPL program and policy issues, initiatives and program changes. The Policy Analyst produces detailed reports, correspondence and written notification for use in cost avoidance and recovery of Medicaid funds and expenditures. This position communicates with attorneys, insurance companies, vendors, providers, clients and other state and federal agencies to secure the recovery of funds, manage projects, and ensure internal policy and procedures are followed, complete and up to date. Also communicates with and handles all policy issues and concerns related to Medicaid TPL programs with other HHS agencies, vendors, federal and state stakeholders and Medicaid clients. Conduct and participate in special studies, and program analysis projects. Responsible for monitoring operation and policy contract requirements related to the claims administrator operations contract and Medicaid managed care organization (MCO) contracts specifically related to TPL programs. This position works under general direction with latitude for the use of initiative and independent judgment.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. Researches, analyzes, and evaluates program and policy issues and initiatives related to Medicaid TPL programs; develops options for recommendations and reports related to these programs; and participates in the development, implementation of policies, procedures and tools that result in recoveries, cost avoidance and direct savings to the Medicaid program. Leads, facilitates, participates, and represents OIG in workgroups and meetings engaged in research, analysis, and evaluation of program and policy issues or initiatives. Includes communicating with vendors, legal counsel, providers, state and federal stakeholders, and other entities to achieve maximum recoveries and receipts for the OIG and HHSC and ensure compliance with all applicable rules and regulations. Prepares detailed project updates, summaries, reports, or other documents related to Medicaid TPL programs and operations and keeps supervisor informed on pertinent issues. Reviews, analyzes, and comments on proposed legislation and regulations affecting assigned TPL program and policy areas. Develops policies, guidelines, procedures and standards to achieve and/or monitor established goals for TPL functions with the OIG and ensures compliance with all state and federal rules and guidelines, including updating appropriately when necessary. Responsible for monitoring operation and policy contract requirements included in the claims administrator operations contract and MCO contracts specifically related to TPL programs.
Knowledge Skills Abilities:
Knowledge of state and federal laws and regulations relevant to the Medicaid program. Knowledge of principles and practices of public administration and management. Knowledge of acceptable and appropriate management and strategic planning techniques, to include analysis, planning, measurement and achievement of established goals. Knowledge of the State Medicaid Manual requirements for the Third Party Liability and Health Insurance Premium Payment (HIPP) program, including those involving the Medicaid Management Information System (MMIS) and its subsystems. Knowledge of claims administration, fiscal agent and MCO procedures related to Third Party Liability. Knowledge of the OIG’s operating procedures as well as HHSC policies and procedures. Skill in researching, developing, analyzing, and evaluating complex program and policy issues. Skill in project management. Skill in managing multiple, sometimes conflicting, priorities without jeopardizing deadlines or system milestone. Skill in presenting complex concepts and information. Skill in collecting and analyzing complex data, evaluating information, and drawing logical conclusions in a prescribed report format. Skill in contract monitoring and contract compliance. Skill in the use of computer and related equipment, including the use of Microsoft Office Suite or equivalent to include word processing, spreadsheet, database, or presentation software programs. Ability to identify problems, evaluate alternatives, and implement effective solutions. Ability to communicate effectively both orally and in writing. Ability to coordinate and negotiate effectively with other staff, departments, officials, agencies, organizations, and the public. Ability to prepare concise reports. Ability to lead workgroups, projects, and meetings. Ability to manage program activities.
Registration or Licensure Requirements:
Initial Selection Criteria:
Minimum 3 years experience in Medicaid policy interpretation, development, and/or implementation, preferably 5 years experience. Experience developing detailed reports and/or project recommendations for leadership. Experience managing multiple projects and competing priorities. Ability to lead workgroups, projects, or meetings. Ability to oversee and monitor contract compliance. Ability to analyze and solve problems. Consideration will also be given to known past job performance, if applicable, and prior work history.
The posted salary range reflects the minimum and maximum allowable by state law. Any employment offer is contingent upon available budgeted funds and the applicant’s experience and qualifications. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual Chapter 7.
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.