Reimbursement Analyst III
About The Position
The Reimbursement Analyst III performs highly advanced (senior-level) rate analysis work related to reimbursement payment rates, data development, and technical analyses under the supervision of the Manager of Cost Report Based Rate Methodology & Supplemental Payments within the Long-Term Services and Supports (LTSS) section in the Provider Finance Department (PFD). The position serves as a subject matter expert on assigned payment programs and oversees the LTSS directed payment programs for Nursing Facilities; a supplemental payment program for Intermediate Care Facilities; directed and supplemental payment rate models; and the development, modification and maintenance of complex computer programs, spreadsheets, and large databases.
Requirements
- Graduation from an accredited 4-year college or university. Experience within Provider Finance may be substituted for education on a year-to-year basis.
- At least one year of experience in advanced written and verbal communication and one year of experience working with large amounts of data, developing payment rates, or conducting complex cost analyses.
Nice To Haves
- At least one year of experience in interpreting state and federal laws and regulations relating to Medicaid reimbursement rates or in the development, implementation, and maintenance of supplemental payment programs preferred.
Responsibilities
- Manages the development and implementation of complex data analysis to determine payments for assigned program.
- Develops, modifies and maintains complex computer programs, spreadsheets and large databases used in rate and/or payment analysis.
- Oversees development, implementation, and processing for LTSS directed payment programs.
- Develops and maintains payment rate models used to make accurate and timely payments to program participants.
- Ensures program procedures and associated processes conform to Texas Administrative Code requirements, and state and federal statutes, rules and guidelines.
- Designs data collection instruments and detailed instruction manuals to collect eligibility and enrollment data from contracted providers for use determining compliance with applicable Texas Administrative Code requirements, and state and federal statutes, rules and guidelines.
- Interfaces with various PFD staff, provider industry representatives, HHS Enterprise staff, legal staff, advisory committees, workgroups and other interested parties concerning program payments, eligibility and funding.
- 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 external entities including but not limited to: contracted providers, provider representatives, client advocates, other agency staff, advisory committees, workgroups, attorneys and other interested parties concerning directed payment and supplemental payment programs.
- Develops department policies and procedures as the subject matter expert for the team and processes policy documents.
- Drafts policy guidelines, agency rules, state plan amendments and other associated documents.
- Develops and implements new program initiatives or enhancements, and new regulations.
- Performs other duties as assigned and as required to maintain efficient program and agency operations.
Benefits
- 100% paid employee health insurance for full-time eligible employees
- A defined benefit pension plan
- Generous time off benefits
- Numerous opportunities for career advancement
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What This Job Offers
Job Type
Full-time
Career Level
Senior
