Reimbursement Analyst V

TX-HHSC-DSHS-DFPS•Austin, TX

2d•Hybrid

About The Position

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. 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. Explore more details on the Benefits of Working at HHS webpage. 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 V (RAV) position reports to the Manager of Acute Care Services Payment Comparison and serves as lead 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 payment rates and reporting, as well as strategic operations and planning. The RAV generates and summarizes written documentation to comply with state and federal rules and regulations, conducts executive briefings, interacts and responds to executive staff requests, and responds to inquiries from providers and other staff as required. Additionally, the RAV reviews work products, trains, and mentors other analysts to ensure high quality team outputs. Provides guidance for operational and tactical planning, program development, and data analysis and evaluation related to services and issues. Work involves establishing goals and objectives, drafting and maintaining policies and procedures, and keeping work products on track to meet deadlines; consulting on priorities, standards, measurement tools, and reporting systems for determining progress in meeting goals. Works under minimal supervision, with extensive 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: 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.

Responsibilities

Keeps reports, documents, and other deliverables on schedule.
Completes detailed analysis of payment rates, claims data, and financial data.
Interprets federal and state statute and regulations to understand applicability and requirements.
Drafts documents as assigned, reviews work of others for accuracy, creates templates, provides feedback to other analysts and leadership.
Prepare documents for, meets with and briefs executive staff on proposed initiatives.
Ensures deliverable and publication dates are met.
Interfaces with various Provider Finance staff, provider industry representatives, HHS Enterprise staff, federal staff, legal staff, advisory committees, workgroups, contracted providers, provider representatives, client advocates, and other interested parties concerning payment rate policy issues affecting program delivery, reporting, and compliance documents.
Provides day‑to-day guidance, mentoring, and technical support to staff on analytical methods, data evaluation, and policy interpretation.
Proactively manage workflow to meet all required notices, submission, and publication of state and federal reports, State Plan Amendments (SPA), and Texas Administrative Code (TAC) updates.
Review work of other analysts to ensure accuracy and quality of work.
Respond to legislative inquiries, complete bill analysis, draft and estimate fiscal impacts, meet with legislative staff and/or attend hearings as required.
Ensures team adherence to established procedures, quality standards, and deliverable timelines.
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.
Performs other work as assigned or required to maintain and support the office and HHSC operations.