Reimbursement Analyst III

TX-HHSC-DSHS-DFPS•Austin, TX

6d•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. Reimbursement Analyst III (RA III) position reports to the Manager of Acute Care Services Fees, Data, and Research and serves as a senior reimbursement analyst for the Acute Care services Fees team. The RAIII 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; calculating out volumes, concentrations, and dosing schedules for clinician administered drugs; 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; collaborating cross-departmentally to ensure accuracy of analysis, authoring, de-bugging, and running SQL queries, 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, queries, 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 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 Interpret data and develop effective operating procedures.
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 Establish goals and objectives.
Ability to Train and 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 developments
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.
Experience with SQL-based data querying software preferred.

Responsibilities

Works with team members, manager, and cross-departmentally 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.
Utilizes Microsoft Excel proficiently.
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.
Provides information to answer questions, may complete or contribute to legislative analysis, open records requests or other items as needed.
Works with the other departments to manage the pipeline of new drugs and their pricing analysis.
Ensures the smooth transaction of information necessary for both teams to implement new drugs to the Medicaid program.
Develops and processes reimbursement aspect of policy documents (including policy guidelines, agency rules, state plan amendments, council and advisory committee items, workgroup materials, memorandums for executive leadership, and other hearing 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

comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees
defined benefit pension plan
generous time off benefits
numerous opportunities for career advancement

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