Reimbursement Analyst III

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The Reimbursement Analyst III performs highly advanced (senior level) rate analysis work of reimbursement payment rates, data development, and technical analyses under the supervision of the Manager of Calculations and Analysis within Long-Term Services and Supports (LTSS) section in the Provider Finance Department (PFD). The position serves as team lead for LTSS Calculations and Analysis Team and oversees LTSS directed payment programs for Nursing Facilities; directed payment rate models; and the development, modification and maintenance of complex computer programs, spreadsheets and large databases. This position is eligible for a hybrid in-office and telework schedule, which is depedent on business needs and subject to change.

Essential Job Functions:

1. Development and Analysis: Oversees development, implementation and maintenance of rate methodologies and rate calculations for directed payment programs. Oversees, develops and conducts rate calculations using advanced statistical techniques. Oversees the development, modification and maintenance of complex computer programs, spreadsheets and large databases used in LTSS directed payments. Ensures calculated rates conform to Texas Administrative Code rules, internal policies and procedures, and general accounting principles. Recommends improvements for rate methodologies and rate calculations. Oversees the design and development, and analysis to evaluate the feasibility and cost implications regarding directed payment rate structure options, new program initiatives or enhancements, special payment rate initiatives, and new regulations. 40%

2. Oversight of Directed Payment Programs: Oversees development, implementation, and processing for LTSS directed payment programs. Develops and maintains payment rate models used to make accurate and timely payments to program participants. Ensures program procedures and associated processes conform to Texas Administrative Code requirements, and state and federal statutes, rules and guidelines. Designs data collection instruments and detailed instruction manuals to collect eligibility and enrollment data from contracted providers for use determining compliance with applicable Texas Administrative Code requirements, and state and federal statutes, rules and guidelines.  30%

3. Leadership: Provides guidance to other PFD LTSS staff on complex, technical and analytical methods used in rate determination. Provides effective planning and organization as a Team Lead for the Calculations and Analysis Team within LTSS PFD; Ensures deadlines are met for required deliverables; Conducts staff training. Develops and processes policy documents relating to payment rate and methodology determination. Ensures compliance with established procedures, requirements, laws, and regulations; completeness of data; and presence of adequate documentation. 15% 

4. Stakeholder and Staff Communications: Interfaces with internal and external stakeholders to provide technical guidance and resolve concerns regarding reimbursement rates or payment rate methodology. Conducts cost survey request and data collection. Participates in public meetings, and records public testimony regarding proposed rates or proposed reimbursements for LTSS programs. Prepares written briefing documents and other documents related to the results of data analysis for decision making by executive staff; Makes presentations of data analysis to a variety of audiences including industry representatives and HHSC executive staff. 10%

5. Performs other duties as assigned and as required to maintain efficient program and agency operations. 5%

Knowledge, Skills and Abilities:

• Experience in data analysis including advanced quantitative analysis.
• Advanced Skills in computer software including Excel, SAS, SPSS, or other statistical analysis software.
• Skill in developing, implementing, interpreting and evaluating policies, procedures, regulations, and laws.
• Ability to exercise independent judgment, set priorities, meet deadlines and adapt to shifting technical and political developments.
• Ability to plan, organize, and coordinate the work of others.
• Ability to establish goals and objectives, coordinate the achievement of established goals and objectives and identify problems and develop creative solutions.
• Ability to communicate effectively both orally and in writing with a variety of agency staff, medical/provider associations, legislative staff, lawyers, state/federal auditors, and interested parties on Medicaid reimbursement issues.

Registrations, Licensure Requirements or Certifications

None.

Initial Screening Criteria:

Graduation from an accredited 4-year college or university. Experience within Provider Finance may be substituted for education on a year-to-year basis.

Experience in leading/managing large projects.

Experience working with large amounts of data to produce complex analyses.

Experience of at least one year in advanced written and verbal communication as demonstrated on the application.

Experience in developing payment rates or conducting complex cost analysis preferred.

Experience interpreting state and federal laws and regulations relating to Medicaid reimbursement rates preferred. 

Experience with the development, implementation and maintenance of supplemental payment programs 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

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.