Provider Recoupments & Holds Team Lead
Listed on 2026-09-21
-
Healthcare
Healthcare Administration
Career Opportunities:
Provider Recoupments & Holds Team Lead (20857)
Posting 20857
-Posted
09/14/2026
- Health & Human Services Comm
- Provider Claims Svcs (75/25)
- Healthcare Support
- Eligible for Telework
-b. $3000 - $4999 per month
Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more.
Explore more details on the Benefits of Working at HHS webpage .
Functional
Title:
Provider Recoupments & Holds Team Lead
Job Title:
Program Specialist V
Agency:Health & Human Services Comm
Department:Provider Claims Svcs (75/25)
Posting Number:20857
Closing Date:10/30/2026
Posting Audience:Internal
Occupational Category:Healthcare Support
Salary Range:$4,523.16-$5,888.50
Pay Frequency: Monthly
Salary Group:TEXAS-B-21
Shift:Day
Additional Shift:None
Telework:Eligible for Telework
Travel:Up to 5%
Regular/Temporary:Regular
Full Time/Part Time:Full time
FLSA Exempt/Non-Exempt:Nonexempt
Facility
Location:
Job Location City:AUSTIN
Job Location Address:701 W 51ST ST
Other Locations:None
MOS Codes: 16GX,60C0,611X,612X,63G0,641X,712X,86M0,8U000,OS,OSS,PERS,YN,YNS
Job Description:
The Texas Health and Human Services Commission (HHSC) Medicaid and CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Program Specialist V in the Provider Recoupments and Holds (PRH) unit. This position is eligible for partial telework in accordance with applicable HHSC policies. Some on-site work will be required.
The Recoupment and Collection Specialist reports to the PRH Manager and performs advanced (senior-level) services and technical assistance work for the PRH unit. This position conducts research and analysis on service authorizations, claim billing and payments, claim holds, and claim recoupments related to Long Term Care (LTC) programs.
The position will run queries and analyze data; update and maintain policies and procedures; identify and provide training to staff and other program areas. The position consults with other program staff to resolve complex or escalated issues. Provides customer service and answers calls received on the LTC provider hotline and communicates with other external customers, HHSC staff, and other agency staff.
The successful candidate works under minimal supervision with extensive latitude for the use of initiative and independent judgment, takes ownership of work, and follows through with assigned tasks. May work on additional projects as needed or other duties as assigned.
Essential Job Functions:
1. Research and Analysis (30%). Processes complex cases including research and analysis of LTC Medicaid service authorizations, claim billing and payments, claim holds, and overpaid claim recoupment information. Performs policy research and serves as a subject matter expert and point of escalation and consultation for other program staff to help resolve complaints or issues. Processes client level collections and serves as a subject matter expert for state staff, Medicaid recipients, and external third-party representatives.
2. Queries and Data Analysis (30%). Gathers data from multiple sources including executing queries to obtain information, performs analysis of query results, creates reports for use by PRH, compares data to identify trends and issues and interprets results. Summarizes results graphically, orally and in writing, and makes recommendations for management review. Develops and maintains standardized Excel tools or queries that can be used by PRH staff to perform tasks.
3. Reporting (20%). Maintains the PRH monthly key performance indicator and service level agreement metric reporting. Executes queries and gathers data from multiple sources to compile and report metrics to the PRH Manager on a monthly and as needed basis. Identifies trends or issues in the reporting metrics and makes recommendations for modifications or improvements for management review.
4.Customer Service (10%). Answers calls received on the LTC provider hotline and provides timely resolution to customers inquiries regarding service authorizations, claim billing and payments, claim holds, and claim recoupments. Coordinates,…
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