Reimbursement Analyst III
About The Position
The Reimbursement Analyst III (RA III) performs consultative services, oversight, policy and data development, and technical analyses under the supervision of the Manager V for the Acute Care School Medicaid Resource and Training team (SMRT) in the Provider Finance Department. This position will function as a subject matter expert in order to provide ongoing education to providers within this program. This position will be responsible for a regionally designated group of Local Education Agency (LEA) providers and act as a key resource and point of contact for those LEAs. This role involves daytime travel, approximately 75% of the work scheduled is designated to regions within the state’s Educational Service Centers (ESC). The ESC regions for this role are within Edinburg, Corpus Christi and San Antonio.
Requirements
- 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.
- Knowledge of reimbursement methods and payment fees, formulas, and procedures.
- Knowledge of claims processing and/or cost report review and completion.
- Knowledge of Texas SHARS, Medicaid Administrative Claiming, Random Moment Time Studies, or other related programs.
- Skill in the review of cost reports and processing of payments.
- Skill in interpersonal relationships and in establishing and maintaining effective working relationships.
- Skill in problem solving, identification of issues and development of creative solutions
- Ability to analyze laws, regulations, program policies, and issues.
- Ability to develop, evaluate, implement, and interpret policies, procedures, and rules.
- Ability to use personal computers and to use word processing, spreadsheet, statistical, and other software to develop payment rates.
- Ability to exercise independent judgement, 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 train staff on policies and procedures related to job functions.
- Ability to lead other staff to accomplish department goals.
- 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/with Medicaid and/or healthcare finance preferred.
- Experience with Salesforce software preferred.
Responsibilities
- Provides technical guidance and support to LEAs participating in the School Health and Related Services (SHARS) program. Travels to all participating LEAs within an assigned geographic region throughout the year to provide in person consultation and guidance. Develops annual key performance indicators to assist LEAs in maximizing federal reimbursement opportunities as participants in the program. (45%)
- Communicates complex information to LEA employed staff 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 the SHARS program. (25%)
- Provides guidance and training to direct service providers regarding eligible billing and claim submission based on prior year cost reported data. (10%)
- Develops and processes policy documents (including policy guidelines, agency rules, state plan amendments, council and advisory committee items, workgroup materials, and hearing other notices) relating to outreach and training for the SHARS program. (10%)
- Performs other work as assigned or required to maintain and support the office and HHSC operations (10%)
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
