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Advanced Financial Services Analyst
2 months ago
Reimbursement Analyst II
The Reimbursement Analyst II (RAII) role is integral to the Financial Services Division, specifically within the Provider Finance Department, under the guidance of the Manager of the Acute Care Supplemental Payments Team.
This position involves advanced responsibilities in crafting payment methodologies for Medicaid supplemental payment initiatives, requiring minimal oversight and allowing for significant initiative and independent decision-making.
Key responsibilities encompass the evaluation and formulation of the payment rate process, which may involve the creation of cost surveys and detailed instructions as necessary. The role also includes managing the payment rate development process for the School Health and Related Services program (SHARS), which involves conducting intricate data analyses to assess and determine payment rates, as well as developing and delivering training on cost reporting while providing technical support to contracted providers, addressing inquiries from providers, cost report preparers, and auditors.
Essential Job Functions:Regular attendance and adherence to agency leave policies are required, along with the performance of additional duties as assigned.
Develops, modifies, and maintains sophisticated computer programs, spreadsheets, and extensive databases related to SHARS and cost reporting. Reviews annual cost reports from Local Education Agencies and issues formal settlement decisions. (50%)
Effectively communicates complex information to both internal and external stakeholders to provide, exchange, or verify information, respond to inquiries, and resolve issues or complaints.
Engages with various contracted providers, their representatives, client advocates, agency personnel, advisory committees, workgroups, attorneys, and other interested parties regarding the School Health and Related Services (SHARS) program.
(20%)
Develops and processes policy documents, including guidelines, agency regulations, state plan amendments, council and advisory committee materials, workgroup documentation, and other notices related to payment rate and methodology determinations.
Prepares documents, reports, and financial analyses for legislative inquiries, rider reports, and to implement initiatives directed by legislation. Schedules and conducts provider training sessions for SHARS. (10%)
Performs additional tasks as assigned or required to support the office and operational functions of the agency. (5%)
Knowledge Skills Abilities:
Comprehensive understanding of health and human service programs, services, and operational procedures.
Familiarity with accounting, business, and management principles, practices, and procedures.
Awareness of state and federal regulations pertaining to Medicaid reimbursement and public administration.
Knowledge of reimbursement methods, payment fees, formulas, and associated procedures.
Understanding of claims processing and cost report review and completion.
Proficiency in developing, implementing, and applying reimbursement methodologies and payment rates.
Strong interpersonal skills and the ability to establish and maintain effective working relationships.
Competence in problem-solving and generating creative solutions.
Aptitude for mathematical calculations and utilizing software for computations.
Ability to analyze laws, regulations, program policies, and relevant issues.
Capability to develop, evaluate, implement, and interpret policies, procedures, and regulations.
Proficient in using personal computers and software applications for word processing, spreadsheets, statistical analysis, and developing payment rates.
Ability to exercise independent judgment, prioritize tasks, meet deadlines, and adapt to evolving technical and political landscapes.Competence in managing projects effectively and delivering high-quality work within tight deadlines.
Ability to communicate effectively, both verbally and in writing, with a diverse range of agency staff, medical/provider associations, client advocates, legislative personnel, legal representatives, state/federal auditors, and other stakeholders on Medicaid reimbursement matters.
Ability to prepare comprehensive briefing documents and reports that convey complex concepts clearly.Ability to train others on policies and procedures relevant to job functions.
