Case Analyst

The Program Specialist V – Case Analyst (CA) is part of the Texas Health and Human Services (HHS) Office of Inspector General (OIG) Chief Counsel Division. The CA performs highly advanced (senior‑level) consultative and technical work. Under the guidance of the Director of Financial Analysis and Case Management, the CA assists with the enforcement of assessed final debt amounts and any associated collection activities.

The duties of this position involve reviewing, researching, analyzing, and evaluating case results, investigative findings, and payments related to complex cases involving health‑care provider fraud, waste and/or abuse in the Medicaid system as well as other Texas Health and Human Service programs. Responsibilities include making recommendations and assisting in processing contract cancellations, exclusions and terminations. The CA interprets policies, procedures, rules, regulations, and standards related to Texas health and human services programs and must ensure compliance with federal and state laws and regulations.

The CA works under general supervision of the Director of Financial Analysis and Case Management or his/her designee. The CA works under limited supervision, with considerable latitude for the use of initiative and independent judgment.

• Assists with the enforcement of assessed final debt amounts, and any associated collection activities – 40%
• Conducts research pertaining to case results, investigative findings, and payments to make determinations and recommendations concerning contract cancellations, exclusions, terminations and or impacted program areas – 40%
• Handles all case closing processes to include scanning and uploading relevant documents into the case management system and case library and closing completed cases – 10%
• Prepares monthly and annual reports with supporting tables and documentation for use by internal and external stakeholders – 5%
• Performs other duties as assigned, keeps manager informed as required or as necessary – 5%

• Knowledge of state and federal laws related to the public health care programs such as Medicaid and Medicare.
• Knowledge of collection processes.
• Skill in use of personal computer, computer software, including spreadsheet, database, and word processing applications.
• Skill in communicating effectively in writing and orally.
• Ability to research facts and law from a variety of databases.
• Ability to review legal and medical files and distill salient information.
• Ability to interpret policies, procedures, rules, regulations, and standards.
• Ability to establish and maintain collegial and collaborative working relationships with co‑workers, agency staff, and management to achieve common goals.
• Ability to manage work time efficiently to complete assignments within a timely manner with limited supervision.

• Graduation from a four‑year college or university, preferably with major coursework in business or health care administration.
• Experience in a field related to business operations involving health care or law may be substituted for the education requirement on a year‑for‑year basis.
• Experience using Microsoft applications – specifically Excel.

• Knowledge of Texas state government structure and functioning.

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 online 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.

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.

This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.