Reimbursement Analyst V

TX-HHSC-DSHS-DFPS • Austin, TX

5d • 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 V (RA V) position reports to the Manager of Acute Care Services Fees, Data, and Research and serves as lead reimbursement analyst for Acute Care services Fees team. The RAV conducts detailed data analysis, generates and summarizes recommendations (both written and financial), conducts executive briefings, interacts and responds to executive staff requests, conducts rate hearings, reviews, trains, and mentors RAIV -  RAI rate analysts to ensure high quality work products and responds to inquiries from providers and other staff as required. 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 to address reviewing guidelines, procedures, rules, and regulations; establishing priorities, standards, measurement tools, and reporting systems for determining progress in meeting goals; coordinating and evaluating program activities; providing training and consultation for staff and directing the development of reports and analytical materials. 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.
• Experience with SQL-based data querying software preferred.

Responsibilities

• Reimbursement Rate Reviews – Keeps rate reviews and rate hearing steps on schedule. Review analysts’ fiscal estimates, identify and correct issues, and provide recommendations as needed. Review and complete required notices, postings, and publications for public rate hearings and rate implementations.  Prepare documents for, meet with and brief executive staff on proposed initiatives.
• Fiscal Analysis – Complete detailed fiscal analysis, pricing reviews, methodology recommendations for provider reimbursement for a variety of programs administered by HHSC.  Work includes compiling information from a variety of datasets, with varying degrees of size and complexity.  Includes special projects, ad-hoc requests, and agency-directed initiatives.
• Federal and State Compliance – Proactively manage workflow to meet all required notices and submission of State Plan Amendments (SPA) and Texas Administrative Code (TAC) updates.  Review work of other analysts to ensure accuracy of work related to SPA and TAC updates related to changes to reimbursement rates.  Respond to legislative inquiries, complete bill analysis, draft and estimate fiscal impacts, meet with legislative staff and/or attend hearings as required.
• Team Representation – Approve biennial workplan, deadline extensions, issues, resolving errors in information received, and implementation status with state contractor(s).  Represent team as a Subject Matter Expert in collaborative efforts with other teams internal to the agency and external stakeholders.
• Performs 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
• Number of Employees: 1,001-5,000 employees