Reimbursement Analyst I

TX-HHSC-DSHS-DFPS•Austin, TX

1d•$4,523 - $7,254•Hybrid

About The Position

The Reimbursement Analyst I position performs advanced technical work in the development of reimbursement rates or supplemental payments and administration of certain financial programs for Medicaid and other programs. This role operates under limited direction with considerable latitude for initiative and independent judgment. Duties include participation in the payment or rate development process, designing cost surveys and instructions, conducting complex data analysis to determine and evaluate payment rates, administering financial programs, and providing technical assistance to contracted providers and auditors. The role also involves developing, modifying, and maintaining complex computer programs, spreadsheets, and large databases for payment rate analysis and supplemental payment calculation, as well as developing policy guidelines, agency rules, and state plan amendments related to payment rate determination.

Requirements

Graduation from an accredited four-year college or university with a bachelor’s degree in social science; business, including accounting and statistics; economics; health-related field; political science; or other closely related field. Experience may be substituted for degree.
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.
Ability to analyze laws, regulations, program policies, and issues.
Ability to develop, evaluate, implement, and interpret policies, procedures, and rules.
Ability to apply complex analytical applications.
Knowledge of reimbursement methods and payment fees, formulas, and procedures.
Ability to development, implement, and apply reimbursement methodologies and payment rates.
Skill in the use of personal computers and to use word processing, spreadsheet, statistical and other software to develop payment rates.
Ability to exercise independent judgment, 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 identify problems and develop creative solutions.
Skill in interpersonal relationships and in establishing and maintaining effective working relationships.
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.
Ability to prepare well-written briefing documents and reports designed to convey complex detailed concepts.

Nice To Haves

Experience in Medicaid or healthcare finance preferred.
Experience with basic accounting principles, applying accounting or statistics, including use of statistical applications, preferred.
Experience in using word processing, spreadsheet, statistical and other software, preferred.

Responsibilities

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.
Develops and conducts surveys to collect cost data from contracted providers for use in payment analysis. Designs cost data collection instruments and detailed instruction manuals to collect cost data from contracted providers for use in payment rate analysis. Provides technical assistance related to cost survey completion, policy, guidelines, and rule requirements.
Develops and implements complex data analysis to determine payment rates for various Medicaid and non-Medicaid programs. Develops, modifies, and maintains complex computer programs, spreadsheets and large databases used in payment rate analysis.
Designs and conducts special cost and statistical research and analysis to evaluate the feasibility and the cost implications affecting provider operations regarding payment rate structure options, new program initiatives or enhancements, special payment rate initiatives, and new regulations.
Develops and processes policy documents (including policy guidelines, agency rules, state plan amendments, council and advisory committee items, workgroup materials, and hearing and other notices) relating to payment rate and payment methodology determination.
Performs other work as assigned or required to maintain and support the office and HHSC operations.