Reimbursement Analyst I

TX-HHSC-DSHS-DFPS•Austin, TX

7d•$4,523 - $7,254•Hybrid

About The Position

This position is hybrid with (currently) two in-office days per week in Austin. Applicants from outside Texas must be willing to relocate within 30 days of hire. Reimbursement Analyst I position performs work for the Provider Finance Department under the supervision of the Acute Care Supplemental Payments Team Manager. Performs highly complex (senior-level) rate analysis work of supplemental payment programs and the administration of School Health and Related Services (SHARS), Medicaid Administrative Claiming (MAC), and Random Moment Time Study (RMTS) programs. Work includes review of Time Study programs, developing and implementing data analysis to determine and evaluate payment rates; preparing cost surveys, instruments, and instructions; and planning, developing, and presenting recommendations and reports. Works under limited supervision, with considerable latitude for the use of initiative and independent judgment. Duties include managing the payment rate development process including performing independent research and gathering information from multiple data sources; conducting complex data analysis to determine and evaluate Medicaid and other payment rates; summarizing analysis and findings in concise documentation; conducting and/or participating in public rate hearings; and providing timely responses to questions by providers and members of the public. Develops, modifies, and maintains complex computer programs, spreadsheets and large databases used in payment rate analysis. Develops reimbursement policy guidelines, agency rules, state plan amendments and other associated documents relating to cost reporting and payment rate determination.

Requirements

Advanced Microsoft Office (Excel, Word, PowerPoint), business objects, TM1P Software, claims processing engines, SQL, R, SAS, Python.
Data analysis, statistics, and data visualization.
Medical claims data, methods of funding, program rules, Medicare, and Medicaid
Texas legislative process.
Health and human service programs, services, and procedures.
Data quality and integrity processes.
Process improvement or quality assurance systems
Knowledge of Texas SHARS, MAC, RMTS, or other related programs.
Managing multiple and competing priorities.
Identifying problems, evaluating alternatives, and implementing solutions.
Working collaboratively and cooperatively with diverse groups.
Establishing goals and objectives.
The development, implementation, and application of reimbursement methodologies and payment programs.
Interpret data and develop effective operating procedures.
Serve as an impartial arbitrator, examining internal and external data to reach an independent conclusion.
Work with large datasets efficiently.
Organize and present information effectively, both orally and in writing to technical and non-technical audiences.
Analyze laws, regulations, program policies, and issues.
Establish effective working relationships with staff at all levels of an organization, agencies, providers, and stakeholders.
Exercise independent judgment, set priorities, meet deadlines, and adapt to shifting technical and political developments
Ability to prepare well-written briefing documents and reports designed to convey complex detailed concepts.
Ability to communicate effectively both orally and in writing with a variety of agency staff, medical/provider associations, client advocates, legislative staff, lawyers, state/federal auditors, and interested parties on Medicaid reimbursement issues

Nice To Haves

Experience with Medicaid and/or healthcare finance preferred.
Experience with SQL-based data querying software preferred.
Experience with Salesforce preferred.

Responsibilities

Financial Modeling - Works with team members and manager to develop and implement complex data analysis related to supplemental payment programs for acute care services. Conducts special cost and statistical research and analysis to evaluate the feasibility and the cost implications about payment rate structure options, new program initiatives or enhancements, special payment rate initiatives, and new regulations. Develops, modifies, and maintains complex computer programs, spreadsheets, and large databases used in payment rate analysis. (40%)
Random Moment Time Study (RMTS) - Develops, modifies, and maintains complex data analysis and statewide time study results used in cost reimbursement and to determine payment rates. Works with providers and HHSC legal on informal and formal appeals resulting from cost report disallowances. This includes extensive research and the ability to testify in court upon request from the HHSC legal department. Responds to inquiries and questions from providers, stakeholders or internal staff. Provides information to answer questions, may complete or contribute to legislative analysis, open records requests or other items as needed. Reviews documentation submitted by outside parties and HHSC staff to make a final determination on RMTS coding. (30%)
Drafting, Publication, and Compliance - Works on monthly deliverables to communicate scorecard information on supplemental payment programs to providers and Medicaid managed care organizations. Responds to questions and requests for information from the Centers for Medicare and Medicaid Services (CMS) as needed on programs. Develops and processes reimbursement aspect of policy documents (including policy guidelines, agency rules, state plan amendments, council and advisory committee items, workgroup materials, and hearing other notices) relating payment rate and payment methodology determination. (15%)
Communication - Communicates information to internal and external parties to provide, exchange, or verify information, answer inquiries, address issues or resolve problems or complaints. Interfaces with various contracted providers, provider representatives, client advocates, other agency staff, advisory committees, workgroups, attorneys, and other interested parties concerning payment rate methodology issues affecting program delivery and payment rate determination. Records and summarizes all forms of public testimony regarding proposed programs. Responds to inquiries and questions from providers, stakeholders or internal staff. Provides information to answer questions, may complete or contribute to legislative analysis, open records requests or other items as needed. Performs trainings for directed or supplemental payment programs as needed. (10%)
Performs other work as assigned or required to maintain and support the office and HHSC operations (5%)