Reimbursement Analyst III

1 month ago

Austin, United States Texas Department of Aging & Disability Services Full time
Job Description:
Reimbursement Analyst III
General Description
•Reimbursement Analyst III (RA III) reports to the Manager of the Research, Development and Methodology (RDM) Team within Long-Term Services and Supports (LTSS) section of the Provider Finance Department (PFD) and performs highly advanced (senior-level) rate analysis work on reimbursement payment rates. Work includes overseeing the development, financial evaluation, and implementation of reimbursement methodologies and payment rates for various Medicaid and non-Medicaid long-term care programs within regular biennial fee review cycle as well as based on changes in programmatic activity.
•RA III oversees planning, analysis, development, and presentation of recommendations and reports and works under minimal supervision, with extensive latitude for the use of initiative and independent judgement.
•RA III will serve as a senior analyst and subject matter expert in LTSS rates and methodologies. Under the direction and assistance of the RDM Manager RA III will mentor junior staff, engage in staff training and help to ensure work is completed accurately and meets required deadlines.
Essential Job Functions:
Essential job functions:
1.Oversees the development and implementation of policy and financial analysis to determine and evaluate payment rates for various long-term care programs and services. Oversees the development, implementation and maintenance of rate methodologies and rate calculations. Work includes preparing ad hoc financial analyses and fiscal estimates.
2.Oversees the design and study of special cost, statistical research, cost surveys and analysis to evaluate the feasibility and cost implications regarding payment structure options, new program initiatives, and new regulations. Contributes to cost report or cost surveys to support rate methodology or programmatic changes. Interprets analysis results and develops recommendations for internal and external audiences.
3.Oversees rate and rule adoption activities, including preparing memorandums and white papers for Executive Leadership, drafting and reviewing of documents to ensure federal approval and authorization in a timely manner as necessary. Develops and processes policy documents relating to payment rate and methodology determination, including state administrative rules, state plan amendments, waiver amendments, etc.
4.Communicates and interfaces with internal and external parties to provide guidance and resolve problems concerning reimbursement rates or payments; rate methodology; rate determination and policy, guidelines, and rule requirements. Provides guidance to PFD LTSS staff on analytical methods used in support of rate methodologies and/or projects. Assists in hiring, mentoring, and training of junior staff. Serves as a subject matter expert of LTSS reimbursement methodologies, models, data, policies and procedures.
5.Actively contributes to the continuous improvement of department processes though ongoing initiatives including: solutions to automate; building efficiencies; maintaining consistency across multiple calculations, models, and rules, promoting reliable analysis techniques and methods. Creates and updates policies and procedures for documenting internal processes and resources, including standard forms and templates. Knowledge Skills Abilities:
Knowledge of Texas Medicaid reimbursement policy and rules is preferred.
Knowledge of methods of quantitative and qualitative analysis, principles, techniques, preferred.
Ability to analyze or evaluate data, calculations and findings, including expertise using Microsoft Excel or statistical software.
Ability to establish and maintain effective work relationships in a team setting.
Ability to communicate effectively in writing, in speaking, and non-verbally.
Ability to communicate complex information to various audiences.
Knowledge of principles for calculating fiscal estimates is preferred.
Knowledge of reimbursement rate development is preferred.
Experience of working with MS Excel, MS Word, SPSS is preferred.

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