Reimbursement Analyst I

TX-HHSC-DSHS-DFPS • Austin, TX

5d • 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. Work includes 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

• Knowledge of: Advanced Microsoft Office (Excel, Word, PowerPoint), business objects, TMHP Software, claims processing engines, SQL, R, SAS, Python.
• Knowledge of: Data analysis, statistics, and data visualization.
• Knowledge of: Medical claims data, methods of funding, program rules, Medicare, and Medicaid
• Knowledge of: Texas legislative process.
• Knowledge of: Health and human service programs, services, and procedures.
• Knowledge of: Data quality and integrity processes.
• Knowledge of: Process improvement or quality assurance systems
• Skill in: Managing multiple and competing priorities.
• Skill in: Identifying problems, evaluating alternatives, and implementing solutions.
• Skill in: Working collaboratively and cooperatively with diverse groups.
• Skill in: Establishing goals and objectives.
• Skill in: The development, implementation, and application of reimbursement methodologies and payment programs.
• Ability to: Interpret data and develop effective operating procedures.
• Ability to: Work with large datasets efficiently.
• Ability to: Organize and present information effectively, both orally and in writing to technical and non-technical audiences.
• Ability to: Analyze laws, regulations, program policies, and issues.
• Ability to: Establish effective working relationships with staff at all levels of an organization, agencies, providers, and stakeholders.
• Ability to: Exercise independent judgment, set priorities, meet deadlines, and adapt to shifting technical and political developments
• Graduation from an accredited four-year college or university with a bachelor’s degree in social science; business, including accounting and statistics; mathematics; physics; economics; health-related field; political science; or other closely related field. Education and work experience can be substituted for one another on a year-for-year basis.

Nice To Haves

• Experience with Medicaid and/or healthcare finance preferred.
• Experience with SQL-based data querying software 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.
• 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 need 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.
• Coordination – Communicate 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.
• Stakeholder Relations – 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.
• Performs other work as assigned or required to maintain and support the office and HHSC operations.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Number of Employees: 1,001-5,000 employees