Job description
Quality Assurance Specialist I
The Texas Health and Human Services Commission Access and Eligibility Services (AES) Eligibility Operations Quality Management department seeks a highly qualified candidate to fill the position of Quality Assurance Specialist I, within Quality Control. This position is available state wide.
AES provides an integrated and streamlined approach to connect individuals to services and supports to reduce institutionalization, allow individuals to remain in their communities, and promote economic and personal self-sufficiency. AES is built on its core values of family, inclusion, commitment, innovation, and excellence. AES strives to achieve its goals of delivering best in class customer service to clients and
stakeholders; strengthening program oversight, integrity, and accuracy; seeking innovative ways to streamline and improve service delivery; creating and promoting a culture of excellence; and promoting departmental efficiencies and responsible stewardship of agency resources. Our staff are well organized; able to multi-task;
possess the ability to continuously learn and improve; able to thrive in a challenging, fast-paced, and evolving environment; and have excellent communication skills, a positive attitude, strong work-ethic, and a desire to help others.
Performs routine social services review functions to assess the accuracy relating to program policies and procedures, specifically Supplemental Nutritional Assistance Program (SNAP), TANF, Medicaid, CHIP and MEPD. This includes data collection and analysis of field cases to ensure
compliance with State policies and Federal regulations. Duties include analyzing case
records, interviewing clients and collateral contacts, and verifying, documenting, and analyzing data. Reports findings to regional staff and participates in special projects as requested. Works under moderate supervision, with limited latitude for the use of initiative and independent judgment.
The Texas Health and Human Services Commission Access and Eligibility Services (AES) Eligibility Operations Quality Management department seeks a highly qualified candidate to fill the position of Quality Assurance Specialist I, within Quality Control. This position is available state wide.
AES provides an integrated and streamlined approach to connect individuals to services and supports to reduce institutionalization, allow individuals to remain in their communities, and promote economic and personal self-sufficiency. AES is built on its core values of family, inclusion, commitment, innovation, and excellence. AES strives to achieve its goals of delivering best in class customer service to clients and
stakeholders; strengthening program oversight, integrity, and accuracy; seeking innovative ways to streamline and improve service delivery; creating and promoting a culture of excellence; and promoting departmental efficiencies and responsible stewardship of agency resources. Our staff are well organized; able to multi-task;
possess the ability to continuously learn and improve; able to thrive in a challenging, fast-paced, and evolving environment; and have excellent communication skills, a positive attitude, strong work-ethic, and a desire to help others.
Performs routine social services review functions to assess the accuracy relating to program policies and procedures, specifically Supplemental Nutritional Assistance Program (SNAP), TANF, Medicaid, CHIP and MEPD. This includes data collection and analysis of field cases to ensure
compliance with State policies and Federal regulations. Duties include analyzing case
records, interviewing clients and collateral contacts, and verifying, documenting, and analyzing data. Reports findings to regional staff and participates in special projects as requested. Works under moderate supervision, with limited 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.
Work involves administering program activities to ensure compliance with state and federal regulations. Ensures accuracy and timeliness of reviews processed by field staff according to federal and state standards. Attends work on a regular and predictable schedule. Contacts and interviews clients or their authorized representatives to verify information found in case records; to verify information discovered during the review process; and to obtain detailed information of the client’s situation at a definite point in time. (50%)
Evaluates information obtained to determine correctness of benefits received by clients. Completes documentation of review findings. (20%)
Contacts financial institutions, governmental entities, medical care providers, corporations, educational facilities, and other sources to validate information. (15%)
Communicates final determination of case review to regional program staff. (15%)
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
Work involves administering program activities to ensure compliance with state and federal regulations. Ensures accuracy and timeliness of reviews processed by field staff according to federal and state standards. Attends work on a regular and predictable schedule. Contacts and interviews clients or their authorized representatives to verify information found in case records; to verify information discovered during the review process; and to obtain detailed information of the client’s situation at a definite point in time. (50%)
Evaluates information obtained to determine correctness of benefits received by clients. Completes documentation of review findings. (20%)
Contacts financial institutions, governmental entities, medical care providers, corporations, educational facilities, and other sources to validate information. (15%)
Communicates final determination of case review to regional program staff. (15%)
Knowledge Skills Abilities:
Knowledge of financial and medical eligibility program policies, QC procedures, and relevant laws.
Skill in attention to detail and discerning accuracy of information provided by clients.
Skill in analytical judgement.
Ability to work independently.
Ability to travel as needed.
Ability to produce accurate work and meet deadlines.
Ability to conduct in-depth interviews with clients or their authorized representatives to obtain necessary facts and information of the client's situation at a given point in time.
Ability to relate to clients who may be hostile or non-cooperative and to elicit information by phrasing questions clearly and concisely at their level of understanding.
Ability to evaluate information from case records in relation to eligibility criteria.
Ability to evaluate information pertinent to determining validity of cases and appropriateness of benefits provided.
Ability to identify appropriate collateral sources of information.
Ability to communicate orally and in writing.
Ability to develop and maintain effective working relationships with others.
Knowledge of financial and medical eligibility program policies, QC procedures, and relevant laws.
Skill in attention to detail and discerning accuracy of information provided by clients.
Skill in analytical judgement.
Ability to work independently.
Ability to travel as needed.
Ability to produce accurate work and meet deadlines.
Ability to conduct in-depth interviews with clients or their authorized representatives to obtain necessary facts and information of the client's situation at a given point in time.
Ability to relate to clients who may be hostile or non-cooperative and to elicit information by phrasing questions clearly and concisely at their level of understanding.
Ability to evaluate information from case records in relation to eligibility criteria.
Ability to evaluate information pertinent to determining validity of cases and appropriateness of benefits provided.
Ability to identify appropriate collateral sources of information.
Ability to communicate orally and in writing.
Ability to develop and maintain effective working relationships with others.
Registration or Licensure Requirements:
N/A
N/A
Initial Selection Criteria:
Must have a minimum of 2 years’ experience as a Texas Works Advisor. • Must be a current HHSC employee (This does not include HHS agencies such as DFPS, DADS, or DARS). • Required experience and knowledge of Texas Works policy for SNAP, TANF, Medicaid, CHIP and MEPD programs • Must have TIERS experience related to eligibility determinations within the last 5 years. • Must be able to travel a minimum of 20%. • Application must be complete (no blank fields) with information sorted in chronological order.
Must have a minimum of 2 years’ experience as a Texas Works Advisor. • Must be a current HHSC employee (This does not include HHS agencies such as DFPS, DADS, or DARS). • Required experience and knowledge of Texas Works policy for SNAP, TANF, Medicaid, CHIP and MEPD programs • Must have TIERS experience related to eligibility determinations within the last 5 years. • Must be able to travel a minimum of 20%. • Application must be complete (no blank fields) with information sorted in chronological order.
Additional Information:
Req # 565061
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.
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.
Req # 565061
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.
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.
MOS Code:
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.
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.
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.
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.
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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