Reimbursement Analyst I

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Reimbursement Analyst I position performs work for the Chief Financial Officer Division, Provider Finance Department under the supervision of the Manager of the Hospital Rates Team. Performs advanced technical work in the development of reimbursement rates or supplemental payments and administration of certain financial programs for Medicaid and other programs under limited direction and with considerable latitude for the use of initiative and independent judgment.

Duties include:

Participation in the payment or rate development process including designing cost surveys and instructions; conducting complex data analysis to determine and evaluate payment rates; conducting public rate hearings; administering financial programs and providing technical assistance to contracted providers and auditors. Develops, modifies, and maintains complex computer programs, spreadsheets and large databases used in payment rate analysis and supplemental payment calculation. Develops policy guidelines, agency rules, state plan amendments and other associated documents relating to payment rate determination.

Essential Job Functions:       

 Attends work on a regular and predictable schedule in accordance with agency leave policy.

1. 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 payment rate methodology issues affecting program delivery and payment rate determination. (25%)

2. Develops and conducts surveys to collect cost data from contracted providers for use in payment analysis. Designs cost data collection instruments and detailed instruction manuals to collect cost data from contracted providers for use in payment rate analysis. Provides technical assistance related to cost survey completion, policy, guidelines and rule requirements. (5%)

3. Develops and implements complex data analysis to determine payment rates for various Medicaid and non-Medicaid programs. Develops, modifies and maintains complex computer programs, spreadsheets and large databases used in payment rate analysis. (30%)

4. Designs and conducts special cost and statistical research and analysis to evaluate the feasibility and the cost implications affecting provider operations with regard to payment rate structure options, new program initiatives or enhancements, special payment rate initiatives, and new regulations. (25%)

5. Develops and processes policy documents (including policy guidelines, agency rules, state plan amendments, council and advisory committee items, workgroup materials, and hearing and other notices) relating to payment rate and payment methodology determination. (10%)

6. Performs other work as assigned or required to maintain and support the office and HHSC operations. (5%)

Registrations, Licensure Requirements or Certifications:  

N/A      

Knowledge Skills Abilities:    

a. Knowledge of health and human service programs, services, and procedures.

b. Knowledge of accounting, business and management principles, practices, and procedures.

c. Knowledge of state and federal laws and regulations relating to Medicaid reimbursement and public administration.

d. Ability to analyze laws, regulations, program policies, and issues.

e. Ability to develop, evaluate, implement, and interpret policies, procedures, and rules.

f. Ability to apply complex analytical applications.

g. Knowledge of reimbursement methods and payment fees, formulas, and procedures.

h. Ability to development, implement, and apply reimbursement methodologies and payment rates.

i. Skill in the use of personal computers and to use word processing, spreadsheet, statistical and other software to develop payment rates.

j. Ability to exercise independent judgment, set priorities, meet deadlines, and adapt to shifting technical and political developments.

k. Ability to manage projects effectively and produce quality work within short deadlines.

l. Ability to identify problems and develop creative solutions.

m. Skill in interpersonal relationships and in establishing and maintaining effective working relationships.

n. 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.

o. Ability to prepare well-written briefing documents and reports designed to convey complex detailed concepts.

Initial Screening Criteria:     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 for degree. Experience in/with Medicaid or healthcare finance preferred. Experience in/with Business Objects or other SQL based data querying software preferred.

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form