Reimbursement Analyst I

Texas Health and Human Services Commission (HHSC) is dedicated to positively impacting the lives of Texans. They are seeking a Reimbursement Analyst I to perform work in the Provider Finance Department, providing technical guidance in the administration of various Medicaid programs and conducting data analysis to determine payment rates.ResponsibilitiesAttends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assignedReviews quarterly and annual cost reports and issues official settlement and reimbursement decisions (30%)Develops, modifies, and maintains complex data analysis and statewide time study results used in cost reimbursement and to determine payment rates. (15%)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 participation, delivery, and payment determination. (15%)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. Documents work processes and escalates issues as needed. (15%)Develops and conducts on-line and/or classroom based educational training programs related to the completion of data collection instruments. (10%)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. (10%)Performs other work as assigned or required to maintain and support the office and HHSC operations (5%)SkillsGraduation from an accredited four-year college or university with a bachelor's degree in social science; business, including accounting and statistics; economics; health-related field; political science; or other closely related fieldExperience of Medicaid and/or healthcare finance preferredExperience with Salesforce software preferredKnowledge of health and human service programs, services, and proceduresKnowledge of accounting, business, and management principles, practices, and proceduresKnowledge of state and federal laws and regulations relating to Medicaid reimbursement and public administrationKnowledge of reimbursement methods and payment fees, formulas, and proceduresKnowledge of claims processing and/or cost report review and completionKnowledge of Texas SHARS, MAC, RMTS, or other related programsSkill in the development, implementation, and application of reimbursement methodologies and payment ratesSkill in the review of cost reports and processing of paymentsSkill in interpersonal relationships and in establishing and maintaining effective working relationshipsSkill in problem solving, identification of issues and development of creative solutionsAbility to analyze laws, regulations, program policies, and issuesAbility to develop, evaluate, implement, and interpret policies, procedures, and rulesAbility to use personal computers and to use word processing, spreadsheet, statistical, and other software to develop payment ratesAbility to exercise independent judgement, set priorities, meet deadlines, and adapt to shifting technical and political developmentsAbility to manage projects effectively and produce quality work within short deadlinesAbility 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 issuesAbility to prepare well-written briefing documents and reports designed to convey complex detailed conceptsExperience of Medicaid and/or healthcare finance preferredExperience with Salesforce software preferredBenefits100% paid employee health insurance for full-time eligible employeesDefined benefit pension planGenerous time off benefitsNumerous opportunities for career advancementCompany OverviewTexas Health and Human Services is an agency that focuses on improving health, safety and well-being. It was founded in 1907, and is headquartered in Austin, Texas, USA, with a workforce of 10001+ employees. Its website is http://hhs.texas.gov.



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