Reimbursement Analyst II

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Brief Job Description:

The Reimbursement Analyst II (RAII) position performs work for the Financial Services Division, Provider Finance Department under the supervision of the Manager VI over the Acute Care Supplemental Payments Team. Performs highly advanced (senior-level) work in the development of payment methodologies for Medicaid supplemental payment programs under minimal supervision and with considerable latitude for the use of initiative and independent judgment. Duties include review and development of the payment rate process which may include designing cost surveys and instructions as needed; conducting complex data analysis to determine, evaluate and recommend payment rates; developing and presenting cost report training; and providing technical assistance to contracted providers, responding to provider requests, cost report preparers and auditors.

Develops, modifies, and maintains complex computer programs, spreadsheets and large databases used in payment rate analysis. Develops reimbursement policy guidelines, agency rules, state plan amendments and other associated documents relating to cost reporting and payment rate determination. Documents and reviews policies and procedures for job duties. May train others on job duties and complete peer reviews.

Essential Job Functions (EJFs):

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.

Develops and implements complex data analysis related to supplemental payment programs for acute care services. Designs and conducts special cost and statistical research and analysis to evaluate the feasibility and the cost implications about payment rate structure options, new program initiatives or enhancements, special payment rate initiatives, and new regulations. Develops, modifies, and maintains complex computer programs, spreadsheets, and large databases used in payment rate analysis. (30%)

Works on, reviews and confirms data included in monthly deliverables to communicate scorecard information on supplemental payment programs to providers and Medicaid managed care organizations. Responds to questions from the Centers for Medicare and Medicaid Services (CMS) as needed on programs. Develops and processes supplemental program documents (including federal guidelines/preprints, agency rules, state plan amendments, council and advisory committee items, workgroup materials, and hearing other notices) relating payment rate and payment methodology determination. (30%)

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 Acute Supplemental payment program, and other related programs. Participates in calls or meetings with external stakeholders as needed to answer questions or address issues as needed. Performs peer reviews on communication and calculations for public distribution drafted by team members.  (20%)

Drafts documents, reports and/or completes financial analysis for both legislative inquiries, rider reports and to implement legislatively directed initiatives. Establish schedule for and conduct provider trainings for some of the directed and supplemental payment programs.  (15%)

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

Knowledge, Skills and Abilities (KSAs):

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.

Skill in the development, implementation, and application of reimbursement methodologies and payment rates.
Skill in interpersonal relationships and in establishing and maintaining effective working relationships.
Skill in problem solving and 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.

Registrations, Licensure Requirements or Certifications:

None Required

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 on a year for year basis. Experience of Medicaid and/or healthcare finance preferred.

Additional Information:

N/A

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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

Telework Disclaimer:

This position may be eligible for telework.  Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.