Reimbursement Analyst III

Location: San Antonio, TX

About the role

The Reimbursement Analyst III (RA III) performs consultative services, oversight, policy and data development, and technical analyses under the supervision of the Manager V for the Acute Care School Medicaid Resource and Training team (SMRT) in the Provider Finance Department. This position will function as a subject matter expert to provide ongoing education to providers within the School Health and Related Services (SHARS) program. The role involves serving as a key resource and point of contact for a regionally designated group of Local Education Agency (LEA) providers, with approximately 75% of work time dedicated to travel within the state’s Educational Service Centers (ESC) regions of Edinburg, Corpus Christi, and San Antonio.

Responsibilities

• Provides technical guidance and support to LEAs participating in the SHARS program.
• Travels to all participating LEAs within an assigned geographic region to provide in-person consultation and guidance.
• Develops annual key performance indicators to assist LEAs in maximizing federal reimbursement opportunities (45%).
• Communicates complex information to LEA staff to address inquiries, issues, or complaints, and interfaces with providers, advocates, agency staff, and other stakeholders (25%).
• Provides guidance and training to direct service providers on eligible billing and claim submission based on prior-year cost-reported data (10%).
• Develops and processes policy documents, including guidelines, agency rules, state plan amendments, and hearing notices related to SHARS outreach and training (10%).
• Performs additional duties to maintain and support office and HHSC operations (10%).

Requirements

• Graduation 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 a closely related field. Experience may substitute on a year-for-year basis.
• Experience in Medicaid and/or healthcare finance preferred.
• Experience with Salesforce software preferred.
• 75% travel required; candidate must reside within or be willing to travel frequently to designated ESCs.

Skills

• 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, payment fees, formulas, and procedures.
• Knowledge of claims processing, cost report review, and completion.
• Knowledge of Texas SHARS, Medicaid Administrative Claiming, Random Moment Time Studies, or related programs.
• Skill in reviewing cost reports and processing payments.
• Skill in interpersonal relationships and maintaining effective working relationships.
• Skill in problem-solving, issue identification, and developing 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, word processing, spreadsheet, statistical, and other software to develop payment rates.
• Ability to exercise independent judgment, 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 lead staff to accomplish department goals.
• Ability to communicate effectively orally and in writing with agency staff, providers, advocates, legislative staff, auditors, and other stakeholders.
• Ability to prepare well-written briefing documents and reports conveying complex concepts.

Benefits

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

Pay

Salary range: $5,098.66 – $8,304.83 per month.

Schedule

• Full-time, regular position.
• Day shift.
• Exempt (FLSA).
• Monthly pay frequency.