Reimbursement Analyst V

TX-HHSC-DSHS-DFPS•Austin, TX

5d•$5,798 - $9,508•Hybrid

About The Position

The Reimbursement Analyst V position performs highly advanced (senior-level) consultative services, oversight, policy and data development, and technical analyses work for the Provider Finance Department under the supervision of the SHARS/MAC/TS Manager within Acute and Acute Care. This position provides technical guidance and performs work in the administration of School Health and Related Services (SHARS), Medicaid Administrative Claiming (MAC), and Random Moment Time Study (RMTS) programs. Duties are performed under limited supervision, with considerable latitude for the use of initiative and independent judgment. This position will act as a team lead and will function as a backup to their supervisor for program matters and this position.

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, MAC, RMTS, or other related programs.
Skill in the development, implementation, and application of reimbursement methodologies and payment rates.
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.
Skill in mathematical calculations and use of associated software to calculate.
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 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.
Ability to train others on policies and procedures related to job functions.

Nice To Haves

Experience of Medicaid and/or healthcare finance preferred.
Experience with Salesforce software preferred.

Responsibilities

Develops, modifies, and maintains complex data analysis and statewide time study results used in cost reimbursement and to determine payment rates.
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 financial methodology issues affecting program participation, delivery, and payment determination.
Reviews quarterly and annual cost reports and issues official settlement and reimbursement decisions.
Develops and processes policy documents (including policy guidelines, agency rules, state plan amendments, council and advisory committee items, workgroup materials,) relating payment rate and payment methodology determination. Documents work processes and escalates issues as needed.
Works with providers and HHSC legal on informal and formal appeals resulting from cost report disallowances. This includes extensive research and the ability to testify in court upon request from the HHSC legal department.
Develops and conducts on-line and/or classroom based educational training programs related to the completion of data collection instruments.
Performs other work as assigned or required to maintain and support the office and HHSC operations.