Provider Recoupments & Holds Team Lead

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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:
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:
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, communicates, and provides program assistance to all internal and external customers.

5.Department Support (10%). Research policies and rules and contributes to the development and updating of P&P documentation and provides ongoing staff training for process modifications or updates. Uses problem solving skills to identify opportunities for improvement, develop possible solutions, obtain feedback from other staff, and present findings to management. Participates in program projects affecting LTC service authorizations, claim billing and payments, claim holds, and claim recoupments, and performs user acceptance testing of new systems or process changes.

Knowledge Skills Abilities:
Knowledge of LTC Medicaid programs and policies.

Knowledge of LTC Medicaid service authorization data elements and Medicaid claim data elements.

Knowledge of LTC Medicaid practices and procedures related to fiscal operations including payments and collections.

Skill in using Microsoft Office software (Access, Excel, Word, Outlook, Teams).

Skill in building spreadsheets, using formulas, and creating data validation requirements using Excel.

Skill in using LTC applications, systems, and tools.

Skill in gathering and analyzing data from multiple sources.

Skill in researching and resolving inquiries related to LTC claim payments and recoupments.

Skill in problem-solving, conflict resolution, and negotiation.

Ability to recognize risks/issues and escalate accordingly.

Ability to balance workload and continuously prioritize requests.

Ability to work independently and collaboratively with other team members.

Ability to communicate effectively both verbally and in writing.

Ability to learn and apply complex policies and procedures.

Registration or Licensure Requirements:
N/A

Initial Selection Criteria:
Graduation from an accredited four-year college or university with a major in business administration or related field. May substitute direct work experience on a year-for-year basis.

1. 4 years’ experience working with LTC Medicaid processing systems.

2. 4 years’ experience analyzing LTC Medicaid claim payment and recoupment data.

3. 4 years’ experience working in a customer service environment, preferably in a call center or hotline.

4. Experience interpreting and explaining policies.

5. Advanced experience using Microsoft Excel.

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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 View phone number on aiapply.co. 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

Telework Disclaimer:

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.