Job Description
Date: May 8, 2026 Location AUSTIN, TX 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: Program Specialist VI Job Title: Program Specialist VI Agency: Health & Human Services Comm Department: Medical&Dental Benefits Policy Posting Number: 16755 Closing Date: 05/22/2026 Posting Audience: Internal and External Occupational Category: Community and Social Services Salary Range: $5,098.66 - $8,304.83 Pay Frequency: Monthly Salary Group: TEXAS-B-23 Shift: Day Additional Shift: Days (First) 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 VI. MCS is driven by its mission to deliver quality, cost-effective services to Texans. This position makes a significant contribution to MCS’s mission by performing highly advanced consultative, technical, and analytical work related to the research, development, and implementation of Medicaid medical benefits policy. This position is the Federally Qualified Health Center (FQHC), Rural Health Clinics (RHC), and Hospital Services subject matter expert and will lead on related medical policy projects and must be proactive in seeking input from other staff in the Medicaid/CHIP Division and demonstrate the ability to work as an effective team member with other divisions within HHSC, and other HHS agencies. This position must be able to research, analyze, and synthesize information such as current standards of care, evidence-based practices, and peer reviewed literature and apply findings to medical benefit policies in review. 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. The Program Specialist VI reports to one of the Medical Benefits Policy Managers. This position works under limited direction of the Manager with extensive latitude for the use of initiative and independent judgment. Essential Job Functions (25%) Serves as the Lead in the development, planning, and implementation of complex new or current medical benefit policies. Researches, analyzes, and synthesizes medical policy documents, complicated federal regulations, client information, and complex claims processing system information for each benefit review. Identifies and provides the applicable Code of Federal Regulations (CFR), State Plan, and Texas Administrative Code (TAC) citations for policy reviews by performing technical research using online resources and electronic databases. Attends medical policy workgroup meetings and provides recommendations on medical policy information verbally or in writing. (25%) Researches, analyzes, and synthesizes very technical information such as standards of care, evidence-based practices, and peer reviewed literature using a variety of resources and websites and applies findings to medical benefit policies. Conducts complex research on MCO benefit coverage, private payer benefit coverage, and other state Medicaid benefit coverage during the policy development process. Assists in the development and review of complicated medical policies including reviewing documentation, policy language development, tracking document research, and reviewing discussions and draft benefit policy changes. Performs complex quality review of policy language and claims processing system changes to ensure all changes are appropriate and have been captured accurate