Specialty Health Quality Assurance Specialist

TX-HHSC-DSHS-DFPS • Austin, TX

16d

About The Position

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.

The Quality Assurance Specialist reports directly to the Administrative Services Manager for Specialty Health (SH). The role performs advanced quality assurance (QA) activities across SH program operations, including assessments and improvements related to call center performance, eligibility processing, provider enrollment, and reimbursement functions. The Quality Assurance Specialist will serve as a subject-matter resource for reviewing service delivery, analyzing performance metrics, and identifying opportunities for improvement. The Quality Assurance Specialist develops and presents clear reports, dashboards, and recommendations for improving operations to SH programs and leadership. This role collaborates with program staff and partners to design quality measures, conduct monitoring, and support improvement initiatives that enhance program efficiency, consistency, accuracy, and client experience.

Requirements

• Knowledge of local, state, and federal laws related to the program areas and, public administration; of quality assurance measurement methods; of statistical sampling and analysis processes; of research and problem-solving techniques; of quality assurance and improvement activities; of administration techniques, training, planning and implementation.
• Skill in identifying measures or indicators of program performance; in measuring program performance and identifying opportunities for improvement; in pursuing quality improvement initiatives; in the use of a computer and applicable software; in using computer systems, electronic mail systems, programs of the Microsoft 365 suite or equivalent; in communicating knowledge effectively to a variety of audiences, both verbally and in writing; in developing and presenting presentations to the public and other agencies.
• Ability to organize and manage multiple tasks with competing deadlines; to interpret state and federal laws, regulations, rules, and policies related to the programs; to identify problems, analyze all relevant information, identify possible solutions and select an appropriate solution; to serve as an expert resource during workgroups or team meetings; to analyze data and produce reports; to identify, carry out, and report progress on critical quality measurements ;to engage in crucial conversations to manage and resolve work-related issues; to communicate and work effectively with individuals and groups and to share knowledge with co-workers; to build and maintain professional relationships with both internal and external stakeholders; to develop and maintain professional relationships with both internal and external stakeholders; to serve as a lead worker providing guidance to others.
• 2 or more years experience in conducting quality assurance, auditing, or compliance activities in a healthcare or public service setting.
• Experience in developing and delivering data reports or dashboards using data visualization software (example PowerBI, Smartsheet, etc.)

Nice To Haves

• Accredited quality certification (Certified Quality Inspector (CQI), Lean Six Sigma, or similar) or project management certification (Agile, PMP, or similar), preferred.

Responsibilities

• Plans, coordinates, and executes quality monitoring plans for call center operations, eligibility processing, provider enrollment, and reimbursement functions.
• Conduct quality reviews of SH program functions, including call evaluation, application and redetermination processing, and claims and payment activities on a regular schedule.
• Reviews, refines, and optimizes quality monitoring procedures and tools to ensure accuracy and alignment with program goals.
• Performs data collection, analysis, and interpretation from quality reviews and operational reports.
• Prepares detailed, actionable reports and dashboards that identify patterns, risks, and performance gaps.
• Summarizes and communicates quality findings to SH leadership and program teams.
• Assist team members with quality reviews and consolidate results into clear summaries and recommendations.
• Collaborates with SH program areas to establish meaningful quality improvement metrics that reflect program expectations and client needs.
• Plans, initiates, and manages improvement initiatives resulting from monitoring findings, patterns, and data trends.
• Conducts root-cause analyses and supports development of improvement plans.
• Oversee the full lifecycle of assigned quality assurance projects, including planning, execution, monitoring, and reporting.
• Maintains and updates project documentation such as project plans, process maps, results summaries, and gap analyses.
• Provides clear recommendations to leadership and program areas on opportunities for improvement and areas needing further review.
• Tracks outcomes of improvement activities to ensure intended results are achieved.
• Serves as a point of contact and subject-matter resource for quality assurance and improvement activities.
• Works with programs to understand operational processes and areas where additional quality review or monitoring may be needed.
• Develops and updates documentation, guidance materials, checklists, review tools, and training resources related to quality standards and monitoring expectations.
• Communicates review findings, improvement needs, and quality expectations in a clear and accessible manner.
• Provides technical assistance to staff and leadership to support implementation of improvement recommendations.
• Supports consistency across SH program areas by clarifying expectations and sharing quality insights with internal teams.
• Other Duties as Assigned. May include participating in disaster response or recovery operations, supporting continuity of operations efforts, and assisting the agency in emergent needs consistent with the responsibilities of this position.

Benefits

• comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees
• defined benefit pension plan
• generous time off benefits
• numerous opportunities for career advancement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 1,001-5,000 employees