Reimbursement Analyst III

TX-HHSC-DSHS-DFPS • Austin, TX

11d • 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.

The Reimbursement Analyst III (RAIII) position reports to the Manager of Acute Care Services Payment Comparison and serves as a senior reimbursement analyst for the Acute Care Services Payment Comparison team. This team is responsible for the design, development, and overall compliance of federal payment rate requirements and reporting. Work involves maintaining complex applications, spreadsheets, and databases used in the determination of comparative payment rates and reporting to support business strategies. The RAIII supports the preparation and validation of routine and ad hoc reports to ensure accuracy, completeness, and compliance with established state and federal rules and regulations.  RAIII compiles, analyzes, and summarizes data for internal reports. Responsibilities include conducting data reviews and quality assurance processes to ensure accurate and timely deliverables. This role supports program operations by executing assigned analytical tasks, monitoring reporting timelines, and identifying data discrepancies for escalation to lead analysts or management. Work is performed under general supervision and receives routine guidance on priorities, standards, and methodologies to support team goals and deadlines, with moderate latitude for the use of initiative and independent judgment.

Requirements

• Knowledge of: Advanced Microsoft Office (Excel, Word, PowerPoint), business objects, TMHP Software, claims processing engines, and data querying/analysis tools such as SQL, R, SAS, Python.
• Knowledge of: Data analysis, statistics, data visualization, medical claims data, methods of funding, program rules, Medicare, and Medicaid.
• Knowledge of: Reimbursement methodologies.
• 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: Communication and public speaking.
• Ability to: Identify discrepancies, determine root cause, evaluate alternatives, and implement solutions.
• 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: Execute goals and objectives.
• Ability to: Provide constructive feedback to staff.
• 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 development.
• 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.

Responsibilities

• Prepare and Maintain Required Reports – Data drafting, review, and publishing. Compile, validate, and produce recurring and ad hoc reports reflecting actual payment rates, reimbursement activities, and related financial data to support federal and state reporting requirements. Maintain reporting tools and data files. Update and maintain spreadsheets, databases, and reporting applications used in tracking actual payment data and producing required deliverables. Document reporting processes and procedures.
• Perform Data Reconciliation and Quality Assurance – Review source data, reconcile variances, identify discrepancies, and escalate issues to senior analysts or management to ensure accuracy and completeness of reporting information. Coordination and communication. Maintain clear and organized documentation of data sources, report logic, and standard operating procedures to support continuity and audit readiness. Compiles requested documents.
• Documentation and Research – Create, define, and document payment rate comparisons.  Identify source materials and define routine analysis in support of report creation. Manage workflows. Conduct background research, create regulatory summaries, produce financial tables, and explain methodologies.  Support compliance documentation.  Assist in preparing documentation, data summaries, and supporting material to demonstrate compliance with state and federal payment rate regulations. Research to respond requests from internal staff, providers, and stakeholders regarding payment data, methodologies, and reporting results under guidance as needed.
• Process and Procedures – Create, define, and document processes and procedures (P&Ps).  P&Ps should facilitate team consistency, quality, knowledge retention, training, efficiency, and productivity.  Maintain P&P documents to reflect current-state processes and continuous improvement. Ensure team is knowledgeable and comply with P&Ps. Conduct preliminary analyses. Identify and flag discrepancies. Conduct root cause analysis. Quantify financial impacts. Support audit readiness and review activities. Assist in monitoring reporting timelines.
• Perform 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: Mid Level