Reimbursement Analyst V

Brief Job Description

This position is hybrid with (currently) two in-office days per week in Austin. Applicants from outside Texas must be willing to relocate within 30 days of hire.

Essential Job Functions (EJFs)

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

• Drafting, Review, and Publishing – Keeps reports, documents, and other deliverables on schedule. Completes detailed analysis of payment rates, claims data, and financial data. Interprets federal and state statute and regulations to understand applicability and requirements. Drafts documents as assigned, reviews work of others for accuracy, creates templates, provides feedback to other analysts and leadership. Prepare documents for, meets with and briefs executive staff on proposed initiatives. Ensures deliverable and publication dates are met.

• Cordination and Communication – Interfaces with various Provider Finance staff, provider industry representatives, HHS Enterprise staff, federal staff, legal staff, advisory committees, workgroups, contracted providers, provider representatives, client advocates, and other interested parties concerning payment rate policy issues affecting program delivery, reporting, and compliance documents. Provides day-to-day guidance, mentoring, and technical support to staff on analytical methods, data evaluation, and policy interpretation.

• Workflow Management – Proactively manage workflow to meet all required notices, submission, and publication of state and federal reports, State Plan Amendments (SPA), and Texas Administrative Code (TAC) updates. Review work of other analysts to ensure accuracy and quality of work. Respond to legislative inquiries, complete bill analysis, draft and estimate fiscal impacts, meet with legislative staff and/or attend hearings as required. Ensures team adherence to established procedures, quality standards, and deliverable timelines.

• Processes and Procedures – Create, define, and document processes and procedures (P&Ps). P&Ps should facilitate team consistency, quality, knowledge retention, training, efficiency, and productivity. Maintain P&P documents to reflect current-state processes and continuous improvement. Ensure team is knowledgeable and comply with P&Ps.

• Performs other work as assigned or required to maintain and support the office and HHSC operations.

Knowledge, Skills and Abilities (KSAs)

• Knowledge of:

  • Advanced Microsoft Office (Excel, Word, PowerPoint), business objects, TMHP Software, claims processing engines, and data querying/analysis tools such as SQL, R, SAS, Python.
  • Data analysis, statistics, data visualization, medical claims data, methods of funding, program rules, Medicare, and Medicaid.
  • Reimbursement methodologies.
  • Texas legislative process.
  • Health and human service programs, services, and procedures.
  • Data quality and integrity processes.
  • Process improvement or quality assurance systems

• Skill in:

  • Managing multiple and competing priorities.
  • Identifying problems, evaluating alternatives, and implementing solutions.
  • Working collaboratively and cooperatively with diverse groups.
  • Communication and public speaking.

• Ability to:

  • Interpret data and develop effective operating procedures.
  • Work with large datasets efficiently.
  • Organize and present information effectively, both orally and in writing to technical and non-technical audiences.
  • Establish goals and objectives.
  • Train and provide constructive feedback to staff.
  • Establish effective working relationships with staff at all levels of an organization, agencies, providers, and stakeholders.
  • Exercise independent judgment, set priorities, meet deadlines, and adapt to shifting technical and political developments

Registrations, Licensure Requirements or Certifications

N/A

Initial Screening Criteria

Graduation from an accredited four-year college or university with a bachelor’s degree in social science; business, including accounting and statistics; mathematics; physics; economics; health-related field; political science; or other closely related field. Education and work experience can be substituted for one another on a year-for-year basis. Experience with Medicaid and/or healthcare finance preferred.

Additional Information

N/A

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Active Duty, Military, Reservists, Guardsmen, and Veterans

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

ADA Accommodations

HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Pre-Employment Checks and Work Eligibility

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

Telework Disclaimer

This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.