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Functional Title: Customer Service Rep IV
Job Title: Customer Services Rep IV
Agency: Health & Human Services Comm
Department: Provider Claims Svcs (75/25)
Posting Audience: Internal and External
Occupational Category: Office and Administrative Support
Salary Range: $3,581.33 - $5,372.41
Additional Shift: Days (First)
Regular/Temporary: Regular
Full Time/Part Time: Full time
FLSA Exempt/Non-Exempt: Nonexempt
Job Location City: AUSTIN
Job Location Address: 701 W 51ST ST
Brief 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.
Essential Job Functions
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%)
Registrations, Licensure Requirements or Certifications
There are no Registrations, Licensure Requirements or Certifications required for this position.
Knowledge, Skills & Abilities
Skill in the use of standard office equipment.
Skill and experience resolving complicated billing issues promptly and efficiently.
Experience utilizing Microsoft Office Excel spreadsheets.
Ability to apply policies and procedures and recommend changes.
Ability to review problems and recommend solutions.
Ability to communicate verbally with stake holders.
Initial Screening Criteria
Two years' 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.
Additional Information
None
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Active Duty, Military, Reservists, Guardsmen, and Veterans:
Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.
ADA Accommodations:
In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS 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.
Pre-Employment Checks and Work Eligibility:
Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.
HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form
