Financial Analyst III-599739
Job Description:
Senior Healthcare Financial Data Analyst
This position is hybrid-1 day in the office and 4 days telework, subject to adjustment based on work needs. This position performs advanced (senior-level) financial analysis and financial regulatory work related to the activities of the Special Projects and Data Analysis unit within Financial Reporting and Audit Coordination. Work involves processing of the Delivery Supplemental Payments (DSP), performing Financial Statistical Report (FSR) to Encounter Reconciliations and other Special Projects and Data Analysis projects. Responsibilities include reviewing, analyzing, and evaluating financial data; preparing reports and responding to inquiries; and recommending appropriate action to resolve financial and regulatory problems. This position reports to the Manager of Special Projects and Data Analysis unit and works under minimal supervision with extensive latitude for the use of initiative and independent judgement. The position utilizes institutional knowledge of Medicaid and calls upon their experience in the intricacies of Medicaid financial reporting to design, implement and maintain financial reporting methods and financial oversight practices for Managed Care Organization (MCO) financial deliverables.
Essential Job Functions:
(25%) Processing of Delivery Supplemental Payment (DSP) claims
Performs the duties of monthly DSP claims processing, report creation, DSP appeals processing and initiating policy/procedure changes and other DSP related matters as well as responding to inquiries about DSP claims processing and policies. Keeps informed of and interprets any changes to Medicaid rules or regulations as they relate to Delivery Supplemental payments. Assists with developing financial Reporting Policies and Procedures to support and comply with those policies. Provides support to all program areas within MCS on all issues related to the DSP payments. Develops new or revised DSP claim report templates and forms. Coordinates with HHSC IT for planning, improvement, and implementation of updates to the DSP Application. Provides guidance, data and consultative services to MCS program areas including HHSC Provider Finance, Actuarial Analysis, HHSC Internal Audit, HHSC Inspector General; Texas State Auditor's Office and any other Federal and State entities regarding Delivery Supplemental payment processes, responds to audit inquiries, presents results to management and makes recommendations. Trains and leads junior staff, as needed.
(45%) Perform the Encounter to Financial Statistical Report (FSR) Paid Claim reconciliations
Performs the quarterly encounter to FSR Paid Claim reconciliations; creates reports on reconciliation results and presents the results to Medicaid CHIP Services Stakeholders to highlight and discuss MCO compliance issues. Collaborates with Managed Care Contracts & Oversight teams to provide reconciliation reports to the MCOs and solicit MCO response with respect to the root cause of any noncompliance and MCOs’ resolution of any issues; maintains a log of MCO historical compliance status and communication related to MCO noncompliance; recommends MCO sanctions and liquidated damages to the Manager, as appropriate. Prepares timely instructions or clarifications to the MCOs regarding proper application of new or revised contractual requirements related to financial and/or encounter reporting in coordination with MCS Operations. Develops training, Policy and Procedure documents related to the reconciliation process. Provides Fiscal Year End reconciliations and coordinates with Actuarial Analysis to assist certification of year end encounters data by the HHSC EQRO (External Quality Review Organization). Trains and leads junior staff, as needed.
(25%) Data Analysis and Financial Reporting
Develops standard and ad-hoc reporting while also providing financial analysis support and expertise in taking on other special projects including Quality Improvement Expense Reporting and providing support to internal stakeholders within FRAC and MCS divisions. Ensures compliance with new procedures, requirements, laws, and regulations; completeness of data; and presence of adequate documentation.
(5%) Researches and interprets rules and regulations; responds to information requests by internal and external stakeholders. This includes collecting and distributing reports, contract documents; relevant statute or regulatory citations; department policies and procedures and desk manuals. Recommends improvements to contract monitoring methodologies to the Manager. The position also suggests ways to do things more effectively. Works to expand knowledge and capabilities.
Knowledge Skills Abilities:
Knowledge of financial analysis principles and techniques, accounting principles, and auditing. Relevant education plus multiple years' experience in accounting and/or finance, with solid grasp of financial and industry terminology and practices. Strong problem-solving, organizational and analytical skills.
Knowledge of state and federal rules and laws related to the Medicaid and CHIP Programs preferred. Additionally, a working knowledge of healthcare management and healthcare insurance programs, and/or MCOs is required. Experience working in Government or at an MCO would be helpful.
Motivated self-starter who consistently demonstrates initiative. Exhibits strong drive to enhance financial operations. Proven capability to learn new material quickly, and to be self-taught. Demonstrated track record of developing improvements and finding new ways to add value to the organization.
Ability to design and perform numerical analyses to develop conclusions from data. Ability to interpret statutes; to evaluate and summarize financial issues; and to assess conformance to procedures, rules, and requirements. Ability to research and interpret contracts, policies, and procedures.
Ability to take responsibility and ownership of projects and processes to assure successful quality completion. Ability to follow instructions when given, and the ability to perform well under minimal supervision. Capability to be flexible.
Ability to be consistently accurate, very detail-oriented, and highly organized. Habit of wanting to "get it right and correct." Demonstrating self-initiative, going beyond the minimum, looking for opportunities for improvement and making suggestions for increased efficiency and accuracy. Strong record-keeping, file-management, and follow-up skills.
Skill in using PC software, particularly proficiency in MS Excel, PowerPoint, Outlook and Word. Capabilities with Business Objects, MS Access or other database software, SQL, VBA and HHSC software such as TIERS would be a significant plus.
Ability to develop positive and productive relationships with external and internal financial\non-financial personnel. Ability to work effectively as a strong contributing team member in a deadline-oriented environment; being a reliable, productive, and flexible contributor, with a positive attitude and a desire to learn.
Skill in written and oral communication, including the ability to produce reports and make occasional public presentations. Ability to research and develop financial policies and procedures. Ability to draft clear and concise correspondence regarding findings.
Experience in managing multiple projects with varying priorities. The ability to devise solutions to develop and evaluate administrative policies and procedures. The ability to prepare cogent and meaningful reports and presentations and to communicate with peers and superiors in an effective way.
Registration or Licensure Requirements:
Graduation from an accredited four-year college or university with major course work in accounting, finance, business administration, management, or statistics is generally preferred.
Initial Selection Criteria:
Graduation from an accredited four-year college or university with major course work in accounting, finance, business administration, management, or statistics is generally preferred. Relevant work experience may substitute year for year.
Additional Information:
An in-basket exercise designed to assess MS Excel skills will be administered after the interview.
Req# 599739
MOS Code:
There are no direct military occupation(s) that relate to the responsibilities, and registration or licensure requirements for this position. All active duty, reservists, guardsmen, and veterans are encouraged to apply if they meet the qualifications for this position.
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In compliance with the Americans with Disabilities Act (ADA), HHS 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.
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