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Functional Title: Certified Clinical Coder - Texas Medicaid - Medical Billing/Coding Job Title: Program Specialist V Agency: Health & Human Services Comm Department: Medical&Dental Benefits Policy Posting Number: 19876 Closing Date: 09/16/2026 Posting Audience: Internal and External Occupational Category: Healthcare Support Salary Range: $4,523.16- $7,253.83 Pay Frequency: MonthlySalary Group: TEXAS-B-21 Shift: Day Additional Shift: Days (First) 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 Certified Clinical Coder - Program Specialist (PS V) reports to one of the Medical and Dental Benefits Policy Managers in the Medicaid and CHIP Services Division.
The position performs advanced consultative and technical medical benefits work related to the development and implementation of Texas Medicaid medical benefits with a focus on clinical/medical billing and coding related projects and questions.
The position analyzes and researches medical billing and coding impacts to Medicaid's medical benefits.
The Certified Clinical Coder (PS V) position identifies need for medical coding changes and makes policy recommendations related to billing and coding, and researches state and federal regulations impacting Medicaid medical benefits.
This position requires excellent writing skills and strong research skills and will participate in medical benefit policy reviews.
This position is expected to understand state and federal Medicaid and CHIP laws and regulations, have knowledge of complex national coding requirements, CMS requirements, and strong knowledge of Medicare and Medicaid billing processes, as well as an awareness of the difference between Medicaid insurance and private payer health insurance.
This position is expected to have experience and strong knowledge of CPT, HCPCS, NCCI and ICD.
This position works under the general direction of the Manager with a high degree of latitude for the use of initiative and independent judgment.
The Certified Clinical Coder Program Specialist V in this position must be proactive in seeking input from other staff in the Medicaid and CHIP Services Department and demonstrate the ability to work as an effective team member within Medical Benefits as well as other divisions and business areas within HHSC.
Essential Job Functions:
(30%) Researches, analyzes, and synthesizes Medicaid medical benefit policy, complicated federal and state regulations, client information, and claims processing information for medical benefit reviews with a focus on clinical/medical coding and billing related projects. Analyzes, researches and tracks quarterly and annual ICD, CPT, HCPCS, and NCCI changes. Conducts research on managed care organization (MCO) benefit coverage, private payer benefit coverage, CMS, and other state Medicaid benefit coverage during the policy development process. Keeps team apprised of billing and coding updates and related information.
(25%) Participates and may lead in the development, planning, and implementation of new or revising current medical benefit policies. 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 and dental benefit policies. Collaborates, as needed, with Medical Benefits staff as well as HHSC staff in other programs and other State agencies and the claims system administrators for program benefit policy development, planning, and implementation. Participates in medical policy meetings and participates in policy discussion by providing comments and recommendations orally or in writing. Performs quality review of policy language and claims processing system to ensure all changes are appropriate and have been captured accurately.
(20%) Provides training, technical assistance, and guidance to staff on clinical coding and billing. Responds in timely manner to internal/external communications and requests for current coding related policy information. Prepares policy updates, summaries, reports, or other documents and keeps management informed of pertinent issues. Works with internal and external stakeholders to identify the need for policy changes through the analysis of claims appeals and denials, provider complaints, billing and coding questions, and prior authorization requests.
(15%) Participates and may lead in public meetings or workgroups engaged in research, analysis, and evaluation of medical benefit issues or initiatives. Acts as the liaison with HHSC staff and other business areas and HHS agencies by providing complex technical assistance and guidance on medical benefit coding and billing related changes during workgroups and meetings. Collaborates with HHSC staff and other HHS agencies to ensure that medical benefits information in the Texas Medicaid Provider Procedures Manual (TMPPM) and other Medicaid materials is accurate and in accordance with policies and procedures. Participates in Post Implementation Utilization Report (PIUR) meetings for medical and dental policies in order to identify if additional benefit changes are necessary and provides guidance and advice on how to implement these changes.
(10%) Assists in developing complex memos, briefs, and other documents for HHSC Executive Leadership regarding medical benefit changes. Develops and provides recommendations for benefit coverage to HHSC Executive Leadership. Supports team members in the development of medical benefit policy. Other duties, as assigned, include but are not limited to actively participating in or serving in a supporting role to meet the agency's obligations.
Knowledge Skills Abilities:
Knowledge of:

• Health and human services agencies and programs, and state and federal Medicaid and CHIP laws and regulations.
• HCPCS, CPT, NCCI and ICD coding information and knowledge of federal and state billing compliance standards.
• CMS and CMS medical coding and billing structures.

Skill in:

• Analyzing and evaluating complex federal and state legislation.
• Researching, analyzing, and synthesizing medical policy, claims processing systems, and program issues.
• Developing and evaluating policies and procedures, assessing risks, and making billing and coding policy recommendations.
• Written and oral communication, including the ability to make public presentations, and write technical information in an understandable format.
• Project planning, evaluation, and implementation.
• Use of Microsoft Office products is required.

Ability to:

• Apply clinical coding expertise to medical benefits or policy.
• Manage several projects concurrently in a fast-paced environment and juggle competing priorities while remaining highly organized.
• Effectively communicate verbally and in writing, facilitate meetings and maintain working relationships with staff or program stakeholders.
• Exercise creative problem-solving techniques in a highly complex environment.
• Work cooperatively as a team member in a fast-paced, deadline-orientated environment.
• Work independently and perform work with a high degree of attention to detail.

Registrations, Licensure Requirements or Certifications:
Medical Billing and Coding certificate is required; preferred through the American Health Information Management Association (CCS-P, CCS) or American Association of Professional Coders (COC, CPC). Proof of current certification is required to be considered for the position.
Initial Selection Criteria:
Required:

• Experience in clinical billing and coding is required.
• Experience in oral and written communication, applying analytical skills and evidence of successfully leading previous projects.
• Graduation from an accredited four-year college or university.

Preferred:

• Experience with hospital, FQHC, and/or RHC billing or policy.
• Major course work in public health, public policy, healthcare administration, or a related field.

Additional Information:
Applicants selected for an interview will be required to submit a resume, a professional or academic writing sample, and may be asked to complete an in-basket exercise.
Salary Note: The salary offered will follow HHS HR Policy and Procedures. The offered salary will be determined in accordance with budgetary limits and the requirements of HHSC Human Resources Manual. For internal applicants, there can be limitations in consideration of applicant's current classification and salary. Salary offers are also dependent upon available budget. Only complete applications meeting criteria as outlined will be considered.
Note: There may be no military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information, see the Texas State Auditor's Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx.
In compliance with the Americans with Disabilities Act (ADA), HHS 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.
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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 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.