Reimbursement Analyst II

Job Description :

The Reimbursement Analyst II position performs work for the Provider Finance Department (PFD) under the supervision of the Manager of the Payments Team.

This position performs highly-advanced (senior-level) consultative services and in the collection of intergovernmental transfers and administration of payments for supplemental or directed payment programs administered by PFD.

The RAII works under minimal supervision and with considerable latitude for the use of initiative and independent judgment to ensure the proper operation of specific payment programs.

• Duties include : planning, review, development and implementation of payment processes, which may include coordinating with other teams within PFD and external stakeholders;
• reconciling data; designing instructions / processes and procedures as needed; conducting complex data analysis to ensure accurate collection of local funding and issuance of payments;

and providing technical assistance to individuals both internal and external to the agency.

Develops, modifies, and maintains complex spreadsheets using large databases to perform payment analysis. Participates in the development of policy guidelines, agency rules, state plan amendments, and other associated documents relating to payments, as directed.

Reviews policies and procedures for job duties and updates documents as necessary to conform to best practices. Responsible for training Reimbursement Analyst I on job duties and completion of peer reviews. Essential Job Functions :

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.

Acts as senior staff for specific Medicaid supplemental and directed payment programs. Coordinates closely with the Team Lead and Manager of the Payments Team to ensure program payment objectives are met in a timely and efficient manner.

Provides guidance and training to other analysts to develop and maintain consistency through standard procedures when processing payments.

Works collaboratively to collect, organize, analyze, and prepare materials in response to requests for information and reports. (25%)

Develops and implements complex data analysis to facilitate and coordinate payments for Medicaid programs. Designs and conducts statistical research and analysis to evaluate payments by entity, program initiative or enhancement, implements special payment rate initiatives, and analyzes new regulations.

Develops, modifies, and maintains complex spreadsheets using large databases to perform payment analysis. (25%)

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 supplemental and directed payment programs. (20%)

Develops and processes policy documents to clearly outline process steps, resources required, and instructions to be used for both staff training and audit responses as needed.

Makes recommendations to enhance existing processes and procedures to reflect best practices. (10%)

Process rate enhancement adjustments for the Long-term Services and Support section of the Provider Finance Department. (10%)

Performs other work as assigned or required to maintain and support the office and HHSC operations (10%) Knowledge Skills Abilities :

Knowledge of health and human service programs, services, and procedures.

Knowledge of accounting, business, and management principles, practices, and procedures.

Knowledge of state and federal laws and regulations relating to Medicaid reimbursement and public administration.

Knowledge of reimbursement methods and payment fees, formulas, and procedures.

Skill in the review of cost reports and processing of payments.

Skill in interpersonal relationships and in establishing and maintaining effective working relationships.

Skill in problem solving, identification of issues and development of creative solutions

Ability to analyze laws, regulations, program policies, and issues.

Ability to develop, evaluate, implement, and interpret policies, procedures, and rules.

Ability to use personal computers and to use word processing, spreadsheet, statistical, and other software

Ability to exercise independent judgement, set priorities, meet deadlines, and adapt to shifting technical and political developments.

Ability to manage projects effectively and produce quality work within short deadlines.

Ability to train staff on policies and procedures related to job functions.

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.

Ability to prepare well-written briefing documents and reports designed to convey complex detailed concepts.