Reimbursement Analyst I

3 months ago

Austin, United States Texas Department of Aging & Disability Services Full time
Job Description:
The Reimbursement Analyst I position performs work for the Financial Services Division, Provider Finance Department under the supervision of the Supplemental Payments Manager within Acute Care. Duties include: Manages the payment rate development process for School Health and Related Services including designing cost surveys and instructions; conducting complex data analysis to determine and evaluate payment rates; developing and presenting cost report training; and providing technical assistance to contracted providers, cost report preparers and auditors. Develops, modifies and maintains complex computer programs, spreadsheets and large databases used in payment rate and cost reporting analysis. Develops policy guidelines, agency rules, state plan amendments and other associated documents relating to cost reporting and payment rate determination. Essential Job Functions:
Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned

Develops, modifies, and maintains complex computer programs, spreadsheets, and large databases related to school based health services and cost reporting. Reviews annual cost reports of Independent School Districts and issues official settlement decisions (40%)

Develops and processes policy documents (including policy guidelines, agency rules, state plan amendments, council and advisory committee items, workgroup materials,) relating payment rate and payment methodology determination. Responds to and processes questions related to reimbursement side of the School Health and Related Services Program. Documents work processes and escalates issues as needed. May conduct on-site audits and provide recommendations to ISDs. Communicates with ISDs, agency staff and other state agencies to coordinate updates to the program. (20%)

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 financial methodology issues affecting program delivery and payment determination. (20%)

Works with providers and HHSC legal on informal and formal appeals resulting from cost report disallowances. This includes extensive research and the ability to testify in court upon request from the HHSC legal department. (15%)

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, 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. Knowledge of reimbursement methods and payment fees, formulas, and procedures.
g. Skill in the development, implementation, and application of reimbursement methodologies and payment rates.
h. Ability to use personal computers and to use word processing, spreadsheet, statistical, and other software to develop payment rates.
i. Ability to exercise independent judgement, set priorities, meet deadlines, and adapt to shifting technical and political developments.
j. Ability to manage projects effectively and produce quality work within short deadlines.
k. Skill in interpersonal relationships and in establishing and maintaining effective working relationships.
l. 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.
m. Ability to prepare well-written briefing documents and reports designed to convey complex detailed concepts.

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