Reimbursement Analyst V

TX-HHSC-DSHS-DFPS•Austin, TX

1d•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. The Reimbursement Analyst V performs highly advanced (senior-level) consultative services, oversight, policy and data development, and technical analyses for the Provider Finance Department under the supervision of a Manager for the Hospital Supplemental Payments team in the Provider Finance Department. This position will act as a team lead and will function as a backup to their supervisor for program matters and this position: 1) provides technical guidance and quality control oversight for calculations and models for various Medicaid supplemental and directed payment programs using complex computer programs, spreadsheets and large databases; 2) coordinates development and implementation of supplemental and directed payment amounts for client services providers and programs; 3) responsible for the development and implementation of, and compliance with, policies and procedures, TAC rules and state plan amendments pertaining to supplemental payment programs; 4) respond to state and federal audits to demonstrate compliance with state and federal statutes and federal rules; 5) collaborates with other team leads and department supervisory staff to research questions and develop recommendations for HHSC Executive staff; and, 6) provides technical assistance to contracted providers, report/survey preparers and auditors. Performs other duties as assigned and required to maintain efficient program and agency operations. Works under minimal supervision, with extensive latitude for the use of initiative and independent judgment.

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 the Texas DSH, UC, CHIRP, UHRIP, GME, 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 and present complex detailed financial concepts
Graduation from an accredited four-year college or university with a bachelor’s degree in social science; business, including accounting and statistics; economics; health-related field; political science; or other closely related field.
Experience may be substituted on a year for year basis.

Nice To Haves

Experience with Medicaid or healthcare finance preferred.
Experience with performing complex formula-based calculations preferred.
Experience with Medicaid claims processing preferred but not required.
Experience in developing supplemental and directed payment amounts or conducting complex cost analysis preferred but not required.
Experience with the development and processing of financial documents both written and spreadsheets preferred but not required.

Responsibilities

Develops and implements complex data analysis to determine payment rates for various Medicaid and non-Medicaid programs.
Designs and conducts cost and statistical research and analysis to evaluate the feasibility and the cost implications with regard to payment rate structure options, new program initiatives or enhancements, special payment rate initiatives, and new regulations.
Develops, modifies, and maintains complex computer programs, spreadsheets, models and large databases used in payment rate analysis.
Provides guidance and recommendations to other rate analysts to develop recommendations for interim reimbursement rates and processing of quarterly claims for payment to participating providers.
Provides guidance and training to others who collect, organize, analyze, and prepare materials in response to requests for information and reports.
Develops documents for presentation of complex financial modeling or requested scenarios to multiple audiences.
Creates one pagers to summarize issues or address questions.
Responds to open records requests with data as needed.
Processes required documents (including supplemental payment related preprints, agency rules, state plan amendments, council and advisory committee items, workgroup materials, and hearing other notices) relating payment rate and payment methodology determination.
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 DSH, UC, GME, and other related programs.
Drafts documents, reports and/or completes financial analysis for both legislative inquiries, rider reports and to implement legislatively directed initiatives.
Performs other work as assigned or required to maintain and support the office and HHSC operations