Reimbursement Analyst I
2 months ago
Reimbursement Analyst I position performs work for the Financial Services Division, Provider Finance Department under the supervision of the Acute Care Manager over the Supplemental Payments Team. Work includes developing and implementing data analysis to determine and evaluate payment rates; preparing cost surveys, instruments, and instructions; and planning, developing, and presenting recommendations and reports. Works under limited supervision, with considerable latitude for the use of initiative and independent judgment. Duties include managing the payment rate development process including performing independent research and gathering information from multiple data sources; conducting complex data analysis to determine and evaluate Medicaid and other payment rates; summarizing analysis and findings in concise documentation; conducting and/or participating in public rate hearings; and providing timely responses to questions by providers and members of the public.
- Develops, modifies, and maintains complex computer programs, spreadsheets and large databases used in payment rate analysis. Develops reimbursement 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.
- Works with team members and manager to develop and implement complex data analysis related to supplemental payment programs for acute care services. 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. (35%)
- Works on monthly deliverables to communicate scorecard information on supplemental payment programs to providers and Medicaid managed care organizations. Responds to questions from the Centers for Medicare and Medicaid Services (CMS) as need on programs. Develops and processes reimbursement aspect of policy documents (including 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. (35%)
- May communicate 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 payment rate methodology issues affecting program delivery and payment rate determination. Records and summarizes all forms of public testimony regarding proposed programs. (15%)
- Responds to inquiries and questions from providers, stakeholders or internal staff. Providers information to answer questions, may complete or contribute to legislative analysis, open records requests or other items as needed. Performs trainings for directed or supplemental payment programs as needed. (10%)
- 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.- h. Ability to use personal computers and to use word processing, spreadsheet, statistical, and other software to develop payment rates.
- i. Ability to use complex formulas in spreadsheet software.
- j. Ability to exercise independent judgement, set priorities, meet deadlines, and adapt to shifting technical and political developments.
- k. Ability to manage projects effectively and produce quality work within short deadlines.
- 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, client advocates, legislative staff, lawyers, state/federal auditors, and interested parties on Medicaid reimbursement issues.
- n. Ability to prepare well-written briefing documents and reports designed to convey complex detailed concepts.
**Registration or Licensure Requirement
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