Reimbursement Analyst I

TX-HHSC-DSHS-DFPS • Austin, TX

5d • Hybrid

About The Position

Reimbursement Analyst I position performs work for the Financial Services Division, Provider Finance Department under the supervision of the Manager of Fee Based Services. Performs highly complex (senior-level) rate analysis work of reimbursement payment rates and pricing. 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 health and human service programs, services, and procedures.
• Knowledge of accounting, business, and management principles, practices, and procedures.
• Knowledge of state and federal laws and regulations relating to Medicaid reimbursement and public administration.
• Knowledge of reimbursement methods and payment fees, formulas, and procedures.
• Skill in the development, implementation, and application of reimbursement methodologies and payment rates.
• Skill in interpersonal relationships and in establishing and maintaining effective working relationships.
• Skill in analyzing laws, regulations, program policies, and issues.
• Skill in use of personal computers and to use word processing, spreadsheet, statistical, and other software to develop payment rates.
• Skill in use of complex formulas in spreadsheet software.
• Skill in preparation of well-written briefing documents and reports designed to convey complex detailed concepts.
• Skill in managing multiple projects with competing deadlines.
• Ability to develop, evaluate, implement, and interpret policies, procedures, and rules.
• Ability to exercise independent judgement, set priorities, meet deadlines, and adapt to shifting technical and political developments.
• Ability to manage projects effectively and produce quality work within short deadlines.
• 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.
• Graduation from an accredited four-year college or university with a bachelor’s degree in social science; business, including accounting and statistics; mathematics; economics; health-related field; political science; or other closely related field. Experience may be substituted on a year for year basis.

Nice To Haves

• Experience with Medicaid and/or healthcare finance preferred.
• Experience with Business Objects or other SQL based data querying software preferred.

Responsibilities

• Works with team members and manager to develop and implement complex data analysis to determine payment rates for various Medicaid and non-Medicaid programs.
• Designs and 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.
• Communicates complex 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 rates.
• Responds to inquiries and questions from providers, stakeholders or internal staff.
• Providers information to answer questions, may complete or contribute to legislative analysis, open records requests or other items as needed.
• Verifies the accuracy of contractor implementation of approved rates
• 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.
• 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