Provider Enrollment Specialist
Texas Health and Human Services Commission, Austin, TX, United States
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 Enrollment Specialist
Job Title:
Program Specialist V
Agency:
Health & Human Services Comm
Department:
Prov Resol and Admin Appeals
Posting Number:
16127
Closing Date:
05/07/2026
Posting Audience:
Internal and External
Occupational Category:
Business and Financial Operations
Salary Range:
$4,523.16- $7,253.83
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:
Austin
MOS Codes:
16GX,60C0,611X,612X,63G0,641X,712X,86M0,8U000,OS,OSS,PERS,YN,YNS
Brief Job Description:
The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Program Specialist V (PE Specialist) in the Provider Enrolment (PE) unit.
The ideal candidate thrives in an environment that emphasizes teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy.
Under the supervision of the Provider Enrollment Manager, the Program Specialist V will act as a provider enrollment expert, focusing on PE program operations, policies and workflows in a fast-paced, evolving environment. Responsibilities include researching and interpreting policies, procedures, rules, regulations, guidance, and standards related to Medicaid provider enrollment daily operations. Providing operational and technical assistance to program staff, PE staff, providers, and State Medicaid contractors. Work involves preparing, editing, and routing communications for providers and managed care organizations. Reviewing and making determinations in the Provider Enrollment Management System (PEMS) for Operations Management (OM) requests. Identifying the root causes of processing delays and errors to make recommendations for gap coverage or backdate enrollments. Offers customer service and assists with monitoring the provider enrollment shared mailbox. Conducts thorough research and analysis of complex inquiries and complaints from clients, agency staff, advocates, healthcare providers, the Ombudsman's office, legislators, and other interested parties using HHSC/TMHP/E-OPM Internet computer systems, and other resources. Acts as a liaison among clients, providers, and contractors to make decisions and resolve issues.
May assist with PE reporting and review the Texas Medicaid Provider Procedures Manual and other documents. May serve as backup in PE work groups. May train others.
Essential Job Functions (EJFs):
Customer Service Support - Assists the Provider Enrollment unit with PE-related questions and complaints. Works with internal and external stakeholders, including contracted vendors, to research and resolve provider questions and complaints. (25%)
Communications - Responds to legislative and external inquiries and requests. Participates in other workgroup meetings. Communicates with industry stakeholder groups such as provider associations and health plan associations. Drafts and reviews guidance and notices to providers with program updates. (25%)
Technical Support - Provides technical assistance to program and PE staff, providers, and State Medicaid contractors. Provides support for updating PE program manuals when operational changes are needed. (15%)
Research and analysis - Interprets policies, procedures, rules, regulations, and standards to make recommendations on operational requests. (15%)
Liaison - Assist and represent PE in workgroups and meetings to disseminate information on PE policy and programmatic initiatives. Prepares agenda, facilitates discussions, and maintains effective working relationships with PE representatives. (10%)
Special Projects - Leads and participates in operational projects affecting the unit. Coordinates with other program areas with minimal oversight. Other duties as assigned. May train others. (10%)
Knowledge, Skills and Abilities (KSAs):
Knowledge of:
Knowledge of the Texas Medicaid program.
Knowledge of customer relations principles and practices.
Knowledge of health and human services programs.
Skill in:
Skill in managing multiple and competing priorities.
Skill in researching, developing, analyzing, and evaluating complex program and policy issues.
Skill in the use of computer and related equipment, including the use of Microsoft Office Suite or equivalent to include word processing, spreadsheet, database, or presentation software programs.
Ability to:
Ability to identify problems, evaluate alternatives, and implement effective solutions.
Ability to communicate effectively orally and in writing.
Ability to coordinate with other staff, departments, officials, agencies, organizations, and the public.
Ability to review and interpret rules.
Ability to lead workgroups, projects, and meetings.
Registrations, Licensure Requirements or Certifications:
N/A
Initial Screening Criteria:
Graduation from an accredited four-year college or university with major course work in Social Sciences (Sociology, Psychology, or Social Work), Health Information Management, Business Administration, or Healthcare Administration / Health Services Administration is preferred. Experience and education may be substituted on a year for year basis. Minimum of 1-year experience researching and evaluating policies or processes for supporting healthcare operations and administrative functions. Minimum of 2 years' experience working in provider/customer service, leading workgroups, projects, and meetings.
Additional Information:
1. Your application must be complete and contain all the requested information. Job histories must demonstrate how you meet the initial selection criteria at a minimum.
2. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual.
3. This position may be eligible for telework in accordance with the HHSC Telework Policies, which includes in-office attendance three days a week. Telework policies are subject to change.
Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC.
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 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.
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.
Functional Title:
Provider Enrollment Specialist
Job Title:
Program Specialist V
Agency:
Health & Human Services Comm
Department:
Prov Resol and Admin Appeals
Posting Number:
16127
Closing Date:
05/07/2026
Posting Audience:
Internal and External
Occupational Category:
Business and Financial Operations
Salary Range:
$4,523.16- $7,253.83
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:
Austin
MOS Codes:
16GX,60C0,611X,612X,63G0,641X,712X,86M0,8U000,OS,OSS,PERS,YN,YNS
Brief Job Description:
The Texas Health and Human Services Commission (HHSC) Medicaid CHIP Services (MCS) department seeks a highly qualified candidate to fill the position of Program Specialist V (PE Specialist) in the Provider Enrolment (PE) unit.
The ideal candidate thrives in an environment that emphasizes teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy.
Under the supervision of the Provider Enrollment Manager, the Program Specialist V will act as a provider enrollment expert, focusing on PE program operations, policies and workflows in a fast-paced, evolving environment. Responsibilities include researching and interpreting policies, procedures, rules, regulations, guidance, and standards related to Medicaid provider enrollment daily operations. Providing operational and technical assistance to program staff, PE staff, providers, and State Medicaid contractors. Work involves preparing, editing, and routing communications for providers and managed care organizations. Reviewing and making determinations in the Provider Enrollment Management System (PEMS) for Operations Management (OM) requests. Identifying the root causes of processing delays and errors to make recommendations for gap coverage or backdate enrollments. Offers customer service and assists with monitoring the provider enrollment shared mailbox. Conducts thorough research and analysis of complex inquiries and complaints from clients, agency staff, advocates, healthcare providers, the Ombudsman's office, legislators, and other interested parties using HHSC/TMHP/E-OPM Internet computer systems, and other resources. Acts as a liaison among clients, providers, and contractors to make decisions and resolve issues.
May assist with PE reporting and review the Texas Medicaid Provider Procedures Manual and other documents. May serve as backup in PE work groups. May train others.
Essential Job Functions (EJFs):
Customer Service Support - Assists the Provider Enrollment unit with PE-related questions and complaints. Works with internal and external stakeholders, including contracted vendors, to research and resolve provider questions and complaints. (25%)
Communications - Responds to legislative and external inquiries and requests. Participates in other workgroup meetings. Communicates with industry stakeholder groups such as provider associations and health plan associations. Drafts and reviews guidance and notices to providers with program updates. (25%)
Technical Support - Provides technical assistance to program and PE staff, providers, and State Medicaid contractors. Provides support for updating PE program manuals when operational changes are needed. (15%)
Research and analysis - Interprets policies, procedures, rules, regulations, and standards to make recommendations on operational requests. (15%)
Liaison - Assist and represent PE in workgroups and meetings to disseminate information on PE policy and programmatic initiatives. Prepares agenda, facilitates discussions, and maintains effective working relationships with PE representatives. (10%)
Special Projects - Leads and participates in operational projects affecting the unit. Coordinates with other program areas with minimal oversight. Other duties as assigned. May train others. (10%)
Knowledge, Skills and Abilities (KSAs):
Knowledge of:
Knowledge of the Texas Medicaid program.
Knowledge of customer relations principles and practices.
Knowledge of health and human services programs.
Skill in:
Skill in managing multiple and competing priorities.
Skill in researching, developing, analyzing, and evaluating complex program and policy issues.
Skill in the use of computer and related equipment, including the use of Microsoft Office Suite or equivalent to include word processing, spreadsheet, database, or presentation software programs.
Ability to:
Ability to identify problems, evaluate alternatives, and implement effective solutions.
Ability to communicate effectively orally and in writing.
Ability to coordinate with other staff, departments, officials, agencies, organizations, and the public.
Ability to review and interpret rules.
Ability to lead workgroups, projects, and meetings.
Registrations, Licensure Requirements or Certifications:
N/A
Initial Screening Criteria:
Graduation from an accredited four-year college or university with major course work in Social Sciences (Sociology, Psychology, or Social Work), Health Information Management, Business Administration, or Healthcare Administration / Health Services Administration is preferred. Experience and education may be substituted on a year for year basis. Minimum of 1-year experience researching and evaluating policies or processes for supporting healthcare operations and administrative functions. Minimum of 2 years' experience working in provider/customer service, leading workgroups, projects, and meetings.
Additional Information:
1. Your application must be complete and contain all the requested information. Job histories must demonstrate how you meet the initial selection criteria at a minimum.
2. Any employment offer is contingent upon available budgeted funds. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual.
3. This position may be eligible for telework in accordance with the HHSC Telework Policies, which includes in-office attendance three days a week. Telework policies are subject to change.
Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC.
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 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.
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.