Coding Reviewer (Remote)

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. 100% paid employee health insurance for full-time eligible employees

a defined benefit pension plan

PASRR Specialized Services Reviewer

Community and Social Services

Shift: Day

Telework: Eligible for Telework

Travel: Up to 5%

Regular/Temporary: Full Time/Part Time: Full time

The Program Specialist IV position reports to the Preadmission Screening and Resident Review (PASRR) Manager within the Intellectual and Developmental Disability (IDD) Services and PASRR Section. The position evaluates supporting documentation, applies applicable PASRR policies and rules, and determines whether requests meet requirements for authorization. This position also provides technical assistance and policy clarification to stakeholders and providers on procedures, policies, and rules related to PASRR, with an emphasis on specialized services authorization and related claims or payment issues. The position identifies, communicates, and supports resolution of documentation or system issues that may affect service authorizations, claims or payments. Works under limited supervision, with moderate latitude for the use of initiative and independent judgment.

Review, adjudicate, and authorize requests for nursing facility specialized services and IDD habilitative specialized services for PASRR-eligible people living in nursing facilities. Provide technical assistance and policy clarification to external providers on PASRR procedures, policies, and rules, including requests for nursing facility specialized services submitted through the TMHP Long Term Care (LTC) Online Portal and IDD habilitative specialized services processed through manual procedures. Assist providers and stakeholders in understanding documentation requirements, authorization outcomes, and issues that may affect PASRR specialized services authorization, claims processing or payment. (Assist with developing program and quality monitoring policies and procedures related to prior authorization of PASRR specialized services. Produce reports of findings, trends, authorization outcomes, and claims-related issues to support monitoring, process improvement, and compliance with PASRR specialized services requirements. (Participate in work groups and TMHP LTC online portal initiatives such as user acceptance testing (UAT) on enhancements to the portal. (Complete other work as assigned by the PASRR Policy Manager or PASRR Specialized Services Lead (5%)

Knowledge of PASRR processes, policies, regulations, and specialized services authorization requirements.

Knowledge of reimbursement claims processing concepts, and factors that may affect claims payment for authorized services.

Analytical and problem‑solving skills to review service requests, evaluate supporting documentation, and identify authorization or claim‑related issues.

Excellent communication skills to provide technical assistance and clarification to various stakeholders.

Skills in using Microsoft Office products.

Ability to communicate effectively both verbally and in writing.

Ability to develop and or maintain complex spreadsheets using Microsoft Excel.

Registrations, Licensure Requirements Or Certifications
Graduation from an accredited four‑year college or university with major course work in a human services field is required. At least 2 years of experience in the IDD services field is preferred.

Knowledge of reimbursement methodologies, claims processing concepts, and healthcare coding or billing practices related to long‑term services and supports is preferred.

Experience reviewing documentation, analyzing authorization or claims issues, and supporting resolution of complex payment concerns is preferred.

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.

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 click.appcast.io. 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.