Reimbursement Analyst I

About the Role

The Reimbursement Analyst I position processes Medicaid and Non-Medicaid cost reports under the supervision of the Manager of the Cost Report Team within the Long-Term Services and Supports (LTSS) section of the Texas Health and Human Services Commission (HHSC) Provider Finance Department (PFD). This position entails technical work in the development and processing of provider cost reports or financial compliance reports for Medicaid and other programs, including calculating reconciliations of cost reports for direct care and patient care expense ratios; processing informal review requests and conducting financial reviews; and maintaining cost report instructions, worksheets, and policies and procedure documentation. This position works under limited direction and with considerable latitude for the use of initiative, prioritizing assigned tasks, and independent judgment.

Responsibilities

• Cost and Financial Compliance Report Informal Reviews (35%): Conducts informal reviews on LTSS cost and financial compliance reports by evaluating the informal review request submitted by the provider and reconciling supporting financial documentation with the adjustments made during HHSC PFD Financial Examination. Ensures informal review adjustments are allowable and processed timely in accordance with Texas Administrative Code rules, program guidelines, and established processes and procedures. Coordinates with the Cost Report Review Unit regarding the results of the informal review. Communicates results of the informal review with stakeholders, including by representing the department in formal appeal hearings.
• Cost Report and Financial Compliance Report Reconciliation (25%): Conducts cost and financial compliance report reconciliations necessary to hold providers accountable to State and Federal requirements across programs and initiatives. Communicates results to providers. Maintains applicable reporting deadlines. Ensures cost and financial compliance reports are processed according to established policies and procedures and Texas Administrative Code rules.
• Cost Report Instructions and Policy Documentation (25%): Drafts instruction documentation for LTSS cost and financial compliance reports. Ensures documentation details how providers should use HHSC's electronic cost reporting system to complete their cost or financial compliance report. Ensures documentation meets accessibility and plain language requirements and HHSC established communication guidelines. Drafts policy documents for external or internal audiences relating to LTSS cost reporting to ensure compliance with established procedures, requirements, laws, and regulations.
• Stakeholder and Staff Communication (10%): 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 payment rate policy issues affecting LTSS cost reporting. Participates in public meetings and records and summarizes public testimony regarding PFD initiatives.
• Other Duties as Assigned (5%): Performs other work as assigned required to maintain and support the office and HHSC operations.

Qualifications

Required: Graduation from a four-year college or university with major coursework in accounting, business administration, finance, economics, statistics, or a related field is required. Experience in Provider Finance or an applicable organization may be substituted for education on a one-to-one basis. Minimum of 1 year of experience in financial examinations, financial analysis, technical writing, Medicaid reimbursement, cost reporting experience, or providing technical guidance is required.

Preferred: Experience in developing, compiling, analyzing, and interpreting statistical data for reimbursement analysis. Experience in working with MS Excel and MS Word.

Skills

• Knowledge of: LTSS cost reporting and financial examination or auditing practices; the Texas Legislative process; Microsoft Word at an advanced level (Styles to format documents, Table Styles, HHS Reports tab, page and section breaks, embedding documents, accessible documents); Microsoft Excel at the intermediate level (footers, headers, margins, sort and filter, conditional formatting, insert links, concatenation, accessible Adobe Acrobat format).
• Strong analytical skills with the ability to collect, analyze, organize, and communicate significant amounts of complex information with attention to detail, accuracy, professionalism, and diplomacy.
• Strong critical thinking skills with the ability to evaluate and implement effective alternative solutions.
• Interpersonal relationships, teamwork, and establishing and maintaining effective working relationships with people at various levels of expertise.
• Communicating clearly and concisely, both verbally and in writing with attention to detail.
• Use of Microsoft Office Suite products (MS Word, Excel, PowerPoint, Outlook, SharePoint, Visio, and others).
• Perform and interpret numerical analyses to analyze, evaluate, and summarize financial and management records for accuracy and conformance to procedures, rules, and regulations.
• Collaborate and work well with others with professionalism and diplomacy.
• Exercise initiative, discretion, and good judgment.
• Work under limited supervision, exercise independent judgment, set priorities, meet deadlines and adapt to shifting technical and work environmental developments.
• Manage projects effectively and produce quality work within expected deadlines.
• Maintain accurate, detailed, and organized documentation of assignments and projects.

Benefits

• 100% paid employee health insurance for full-time eligible employees
• Defined benefit pension plan
• Generous time off benefits
• Numerous opportunities for career advancement

Schedule

Day shift. This position may be eligible for telework. Full-time regular position. Travel up to 5%. Salary range: $4,523.16 - $7,253.83 per month.