CSHCN Eligibility Specialist

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Employee Benefits:

DSHS offers insurance coverage and other benefits available through the State of Texas Group Benefits Plan administered by the Employee Retirement System of Texas (ERS). To learn more about all the benefits available to you as a DSHS employee and other DSHS opportunities for early career pathways, visit the DSHS Careers Page.

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Functional

Title:

CSHCN Eligibility Specialist

Job Title:

Publ Hlth and Prevent Spcl III

Agency:
Dept of State Health Services

Department:
Region 4/5

Posting Number: 13191

Closing Date: 03/11/2026

Posting Audience:
Internal and External

Occupational Category:
Community and Social Services

Salary Group: TEXAS-B-18

Salary Range: $3,793.41 - $4,857.33

Pay Frequency:
Monthly

Shift: Day

Additional

Shift:

Telework:

Travel:
Up to 30%

Regular/Temporary:
Regular

Full Time/Part Time:
Full time

FLSA Exempt/Non-Exempt:
Nonexempt

Facility

Location:

Job Location City: TYLER

Job Location Address: 2521 W FRONT ST

Other Locations:

MOS Codes: 230X,43EX,43HX,4B0X1,4E0X1,60C,68S,68Z,HM,HS,MED,NAP
11,SEI
12

Job Description:

Under the supervision of the Regional Manager of Specialized Health/Social Services or designee, participates as a member of the comprehensive social work program (Children with Special Health Care Needs Services Program (CSHCN-SP), Newborn Screening (NBS), Newborn Hearing Screening (NBHS), Childhood Lead Poisoning Prevention Program (CLPPP), Personal Care Services and Private Duty Nursing (PCS/PDN), and Children's Health Insurance Program (CHIP). Works under moderate supervision with limited latitude for use of initiative and independent judgment, performs complex public health and human services work, and renders decisions on Children with Special Health Care Needs (CSHCN) Program eligibility for clients in HSR 4/5N.

Provides complex reviews of CSHCN applications, including reviews of financial and medical information to determine applicability of CSHCN Program rules. Interprets and complies with CSHCN rules, regulations, policies and procedures relating to CSHCN eligibility. Follows established procedures for CSHCN automated "IBIS" system eligibility processing. Develops, coordinates and maintains up to date records of all applications and outcome determinations processed and collects data, keeping breakdown totals on those received, approved, denied, sent to Austin for appeal and ones processed under specific spenddown procedures.

Also maintains program statistics. Assures daily determination information letters are generated and audited, including information for Medicaid/Medically Needy Program and Children's Health Insurance Program (CHIP), which are necessary for the completion of the CSHCN application process. Serves as a public resource and confers on a daily basis with other regional eligibility personnel, social workers, medical staff, and personnel from other agencies to provide technical assistance, policy, interpretation/updates, problem resolution, and follow up on incomplete applications.

Maintains computer database, files, documentation, reports and performs routine clerical duties for assigned social work staff. Works as part of a team with other eligibility staff. Employee actively participates and/or serves in a supporting role to meet the agency's obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Maintains confidentiality. Attends to other assignments as directed by Regional Manager of Specialized Health/Social Services or designee.

Provides translation services (English and Spanish) as needed.

Essential Job Functions:

30%:
Performs complex reviews of applications for determination of program eligibility including evaluating applications and supplemental information for eligibility bases on financial, residency, age and medical criteria; performs complex data entry; interviews applicants and collateral sources as necessary to follow-up incomplete applications. Provides translation services (Spanish and English) as needed.

30%:
Provides technical assistance to regional social work staff, CSHCN providers and/or potential providers concerning provider enrollment, authorization and claims processing. Assists case managers in the resolution of problems between clients, providers of services, and regional staff. Works directly with providers to obtain authorizations for services and filing claims as needed. Provides interpretation of relevant changes as they occur. May interview and provide guidance and assistance to clients with completion and submission of eligibility applications for Medicaid/Medically Need Program and CHIP, assuring compliance with timelines mandated by the CSHCN Program.

Answers or returns all…