Reimbursement Analyst III

TX-HHSC-DSHS-DFPS•Austin, TX

3d•$5,099 - $8,304•Hybrid

About The Position

The Reimbursement Analyst III position processes Medicaid and Non-Medicaid cost reports under the supervision of the Manger of the Cost Report Team within the Long-Term Services and Supports (LTSS) section of the Texas Health and Human Services Commission (HHSC) Provider Finance Department (PFD). The position entails complex (senior-level) technical work in the development and processing of provider cost reports or financial compliance reports for Medicaid and other programs, including calculating reconciliations of cost reports for direct care and patient care expense ratios; processing informal review requests and conducting financial reviews; developing new processes and process improvements; and maintaining cost report instructions, worksheets, and policies and procedure documentation. This position works under general supervision with moderate latitude for the use of initiative, prioritizing assigned tasks, and independent judgment.

Requirements

Graduation from a four-year college or university with major coursework in accounting, business administration, finance, economics, statistics, or a related field is required. Experience in Provider Finance or applicable organization may be substituted for education on a one-to-one basis.
Experience with financial analysis is required.
Knowledge of LTSS cost reporting and financial examination or auditing practices.
Knowledge of The Texas Legislative process.
Knowledge of Microsoft Word at an advanced level and the use of HHS accessible templates. (Use of Styles to format documents, Table Styles, HHS Reports tab to create and format reports, page and section breaks to format long documents with different page styles, embedding documents, and able to create accessible documents).
Knowledge of Microsoft Excel at the intermediate level. (Set up footers, headers, align margins, sort and filter, conditional formatting, insert links, concatenation, able to convert to accessible Adobe Acrobat format).
Strong analytical skills with the ability to collect, analyze, organize, and communicate significant amounts of complex information with attention to detail, accuracy, professionalism, and diplomacy.
Strong critical thinking skills with the ability to evaluate and implement effective alternative solutions.
Interpersonal relationships, teamwork, and establishing and maintaining effective working relationships with people at various levels of expertise.
Communicating clearly and concisely, both verbally and in writing with attention to detail.
Use of Microsoft Office Suite products (MS Word, Excel, PowerPoint, Outlook, SharePoint, Visio, and others).
Perform and interpret numerical analyses to analyze, evaluate, and summarize financial and management records for accuracy and conformance to procedures, rules, and regulations.
Collaborate and work well with others with professionalism and diplomacy.
Exercise initiative, discretion, and good judgment.
Work under limited supervision, exercise independent judgment, set priorities, meet deadlines and adapt to shifting technical and work environmental developments.
Manage projects effectively and produce quality work within expected deadlines.
Maintain accurate, detailed, and organized documentation of assignments and projects.

Nice To Haves

Experience in developing, compiling, analyzing, and interpreting statistical data for reimbursement analysis, preferred.
Experience with policy analysis, preferred.
Experience of working with MS Excel, MS Word, and SQL, preferred.

Responsibilities

Conducts informal reviews on LTSS cost and financial compliance reports by evaluating the informal review request submitted by the provider and reconciling supporting financial documentation with the adjustments made during HHSC PFD Financial Examination.
Ensures informal review adjustments are allowable and processed timely in accordance with Texas Administrative Code rules, program guidelines, and established processes and procedures.
Coordinates with the Cost Report Review Unit regarding the results of the informal review.
Communicates results of the informal review with stakeholders, including by representing the department in formal appeal hearings.
Conducts cost and financial compliance report reconciliations necessary to hold providers accountable to State and Federal requirements across programs and initiatives.
Communicates results to providers.
Maintains applicable reporting deadlines.
Ensures cost and financial compliance reports are processed according to established policies and procedures and Texas Administrative Code rules.
Drafts instruction documentation for LTSS cost and financial compliance reports.
Ensures documentation details how providers should use HHSC’s electronic cost reporting system to complete their cost or financial compliance report.
Ensures documentation meets accessibility and plain language requirements and HHSC established communication guidelines.
Drafts policy documents for external or internal audiences relating to LTSS cost reporting to ensure compliance with established procedures, requirements, laws, and regulations.
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 policy issues affecting LTSS cost reporting.
Participates in public meetings and records and summarizes public testimony regarding PFD initiatives.
Works with senior-level teammates to conduct cost report reviews and improvements.
Updates cost reports as program and reporting requirements change.
Develops new cost reports to meet data collection and reporting requirements for LTSS programs.
Conducts peer reviews and acts as a resource for junior staff in the completion of informal reviews and reconciliations.
Coordinates among teammates to analyze processes and develop process improvements.
Performs other work as assigned required to maintain and support the office and HHSC operations.