Job Description:
The Reimbursement Analyst III (RA III) performs highly advanced (senior-level) consultative services, oversight, policy and data development, and technical analyses for the Provider Finance Department under the supervision of the Manager V for the Acute Care 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 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.
Essential Job Functions:
Essential Job Functions:
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 to determine payment rates for various Medicaid and non-Medicaid programs. 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. (25%)
Provides guidance and recommendations to other 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. (25%)
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, CHIRP, GME, and other related programs. Sends state action requests to implement rates for new benefits or for updates. (20%)
Develops and processes policy documents (including reimbursement policy guidelines, agency rules, state plan amendments, council and advisory committee items, workgroup materials, and hearing other notices) relating payment rate and payment methodology determination. (10%)
Drafts documents, reports and/or completes financial analysis for both legislative inquires, rider reports and to implement legislatively directed initiatives. Establish schedule for and conduct provider trainings for some of the directed and supplemental payment programs. Conduct cost report trainings for applicable programs as needed. (10%)
Performs other work as assigned or required to maintain and support the office and HHSC operations (10%)
Knowledge Skills Abilities:
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 complex detailed concepts
Registration or Licensure Requirements:
None Required
Initial Selection Criteria:
Graduation from an accredited four-year college or university with a bachelor’s degree, relevant experience may be substituted for education on a year to year basis, in social science; business, including accounting and statistics; economics; health-related field; political science; or other closely related field. Knowledge of Medicaid and/or healthcare finance preferred.
MOS Code:
Note: There may be no military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position. All active duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information see the Texas State Auditor’s Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx.
Top 10 Tips for Success when Applying to Jobs at HHSC and DSHS
HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.
In compliance with the Americans with Disabilities Act (ADA), HHS 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.