Senior Financial Analyst for Hospital Reimbursement
About The Position
This position offers an opportunity to combine analytical skills with public service impact. The Senior Financial Analyst for Hospital Reimbursement in Rate Setting will help design and implement equitable, data-driven reimbursement systems that sustain access to high-quality care. This position will analyze hospital claims data as well as other financial data including cost reports and financial statements to shape hospital reimbursement reform and ensure MaineCare’s hospital payment models are sustainable, equitable, and aligned with quality care outcomes. Support MaineCare’s transition toward more value-driven and transparent hospital payment systems by developing data models and financial tools that link cost, utilization, and outcomes. Review claims data to understand hospital billing practices and trends and communicate actionable information to senior leadership. Track federal and state legislation and policy changes impacting hospitals and estimate potential provider and fiscal impacts. Create and lead presentations to internal Department groups and external providers or partners. Lead work to develop and implement policies impacting hospitals by partnering with program staff from OMS Policy, Delivery System Reform, Provider Relations, other OMS units, and other DHHS Offices. Refer potential fraud, waste, and abuse in hospital billing and reimbursement to OMS Program Integrity staff. Evaluate and model the fiscal impacts of proposed reimbursement strategies. Provide senior leadership with actionable insights that guide multimillion-dollar hospital payment decisions. Analyze post-implementation impacts of adopted changes to reimbursement policies. Generate supplemental payment files to hospitals. Serve as the subject matter expert on hospital cost reports and understand financial pressures hospitals are facing. Create reports or dashboards with important hospital data and key metrics. Troubleshoot and respond to questions and issues that arise related to hospital reimbursement.
Requirements
- An eight (8) year combination of education and/or experience comprised of a Master’s Degree in Business Administration, Non-Profit Administration, Finance, Health Care Administration or a closely related field and two (2) years of experience in cost, budget, and financial analysis.
- Directly related professional experience may be substituted for education on a year-for-year basis.
- Experience working with hospital cost reports, financial statements, and claims data.
- Strong written and oral communication skills, including the ability to lead meetings and public presentations.
- Experience using analytics tools with the ability to write SQL queries.
- Able to research law, regulations, and Medicaid policies to provide sound advice and recommendations to executive managers.
- Able to synthesize and present complicated analysis and technical information in an understandable and concise manner to support decision-making.
Nice To Haves
- Experience with and knowledge of the Medicaid program and/or other health and human services programs serving low-income populations
- Lived experience with Medicaid and/or other health-related social needs common to individuals and families receiving Medicaid coverage
Responsibilities
- Analyze hospital claims data as well as other financial data including cost reports and financial statements to shape hospital reimbursement reform and ensure MaineCare’s hospital payment models are sustainable, equitable, and aligned with quality care outcomes.
- Support MaineCare’s transition toward more value-driven and transparent hospital payment systems by developing data models and financial tools that link cost, utilization, and outcomes.
- Review claims data to understand hospital billing practices and trends and communicate actionable information to senior leadership.
- Track federal and state legislation and policy changes impacting hospitals and estimate potential provider and fiscal impacts.
- Create and lead presentations to internal Department groups and external providers or partners.
- Lead work to develop and implement policies impacting hospitals by partnering with program staff from OMS Policy, Delivery System Reform, Provider Relations, other OMS units, and other DHHS Offices.
- Refer potential fraud, waste, and abuse in hospital billing and reimbursement to OMS Program Integrity staff.
- Evaluate and model the fiscal impacts of proposed reimbursement strategies.
- Provide senior leadership with actionable insights that guide multimillion-dollar hospital payment decisions.
- Analyze post-implementation impacts of adopted changes to reimbursement policies.
- Generate supplemental payment files to hospitals.
- Serve as the subject matter expert on hospital cost reports and understand financial pressures hospitals are facing.
- Create reports or dashboards with important hospital data and key metrics.
- Troubleshoot and respond to questions and issues that arise related to hospital reimbursement.
Benefits
- 13 paid holidays
- 12 days of sick leave
- 3+ weeks of vacation leave annually
- Health Insurance Coverage – The State of Maine pays 85%-100% of employee-only premiums
- Health Insurance Premium Credit – Participation decreases employee-only premiums by 5%
- Dental Insurance – The State of Maine pays 100% of employee-only dental premiums
- Retirement Plan – The State contributes the equivalent of 18.91% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS)
- Six weeks of fully paid parental leave
- Additional, unpaid leave may also be available, under the Family and Medical Leave Act.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
