Reimbursement Analyst III

4 weeks ago

Austin, United States Texas Department of Aging & Disability Services Full time
Job Description:
The Reimbursement Analyst III performs highly advanced oversight, policy and data development, and technical analyses for the Chief Financial Officer Division, Provider Finance Department. This position will be under the supervision of the Manager V of the Hospital Rates team.

The position oversees:
1) development and implementation of, and compliance with, policies and procedures, TAC rules and state plan amendments pertaining to rate methodologies and rates or supplemental payment programs;
2) compliance with state and federal statutes and federal rules;
3) development and implementation of effective techniques for monitoring, evaluating and updating procedures pertaining to the collection and review of provider cost data or other financial data;
4) Manages the development and implementation of complex data analysis to determine payment rates for various Medicaid programs; and
5) Participates in the development of research initiatives and collaborates with Data and Research Analysts to evaluate emerging trends, impacts of reimbursement rates and payments, and to respond to stakeholder requests.

Duties include: overseeing the development and implementation of rate methodologies and payment rates for client services providers and programs; overseeing complex data analyses and interpretation; providing effective planning, organization and guidance to reimbursement analyst staff; identifying needed areas of change and overseeing the development of alternative strategies and recommendations.

The position:
1) provides technical guidance and oversight on cost and trend analysis and research projects to evaluate the feasibility and cost implications of various rate structures, program initiatives or enhancements, and regulations;
2) oversees collection of appropriate data necessary to determine payment rates;
3) manages the development, modification and maintenance of complex computer programs, spreadsheets and large databases;
4) collaborates with other team leads and department supervisory staff to research and develop recommendations for HHSC Executive staff; and,
5) 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.
Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.

Oversees development and implementation of, and compliance with, policy guidelines, agency rules, state plan amendments and other associated documents pertaining to reimbursement methodologies and payment rates. (20%)

Develops, modifies and maintains complex computer programs, spreadsheets and large databases used in payment rate analysis. (10%)

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. Develops and conducts educational training programs related to the completion of the data collection instruments. Provides technical assistance related to cost survey completion, policy guidelines and rule requirements. (15%)

Provides advanced technical guidance, effective planning, organization and direction to assigned Rate Analyst Staff. (15%)

Designs and conducts special cost and statistical research and analysis to evaluate the feasibility and the cost implications affecting contracted provider operations with regard to payment rate structure options, new program initiates or enhancements, special payment rate initiatives and new regulations. (15%)

Communicates complex information to internal and external parties to provide exchange or verify information, answer inquires, 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 policy issues affecting program delivery and payment rate determination. (15%)

Manages workload by planning and organizing workload to prioritize and meet deadlines. Controls progress and quality of work by communicating with Manager, evaluating status and priority of assignments, and making necessary adjustments in workload to meet deadlines. (5%)

Performs other work as assigned or required to maintain and support the office and HHSC operations. (5%)
Knowledge Skills Abilities:
a. Knowledge of health and human service programs, services, and procedures.
b. Knowledge of accounting, business and management principles and practices and procedures.
c. Knowledge of state and federal laws and regulations relating to Medicaid reimbursement and public administration.
d. Skill in developing, implementing, interpreting and evaluating policies, procedures, regulations, and laws.
e. Ability to apply complex analytical applications.
f. Knowledge and skill in development of reimbursement methods and payment fees, formulas, and procedures.
g. Ability to use personal computers and to use word processing, spreadsheet, statistical and other software to analyze large, complex databases and develop payment rates.
h. Ability to exercise independent judgment, set priorities, meet deadlines and adapt to shifting technical and political developments.
i. Ability to manage projects effectively, and produce quality work within short deadlines.
j. Ability to plan, organize, and coordinate the work of others.
k. Ability to establish goals and objectives, coordinate the achievement of established goals and objectives and identify problems and develop creative solutions.
l. Skill in interpersonal relationships and in establishing and maintaining effective working relationships.
m. 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

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