PROSPECTIVE PAYMENT SYSTEM (PPS) ANALYST - 81677

State of Tennessee; Nashville (TN); Hybrid; USD 65,000 - 90,000; Full time

Job summary

State of Tennessee is seeking a Prospective Payment System (PPS) Analyst in Nashville within the TennCare Division. The role focuses on overseeing PPS for FQHCs and RHCs, with collaboration across budget and policy teams in a hybrid work environment.

The successful candidate will analyze reimbursement data, update policies, and prepare reports while liaising with providers and agency leadership. A master’s or bachelor’s with experience is required.

Qualifications

• Master's degree in business, public administration, public health, public policy, or related field.
• OR a bachelor's degree with 3+ years of related work experience.
• Strong analytical skills with ability to identify trends in data.
• Proven problem-solving skills and ability to improve business processes.
• Proficiency in Microsoft Excel and Word.
• Excellent oral and written communication skills.
• Strong organizational skills and ability to manage multiple tasks.

Responsibilities

• Assist with daily PPS oversight for FQHCs and RHCs.
• Collaborate with the Comptroller's Office to administer PPS and address reimbursements.
• Serve as a liaison to providers, answering inquiries and providing technical assistance.
• Review change-in-scope applications submitted by FQHCs and RHCs.
• Monitor reimbursement data and fiscal metrics to support program administration.
• Update PPS policies, procedures, and documentation.
• Produce recurring reports and ad hoc analyses on PPS operations.
• Support special projects and policy research related to provider reimbursement.

Skills

Analytical thinking

Problem-solving

Communication skills

Organizational skills

Education

Master's degree in relevant field

Bachelor's degree with 3+ years of related experience

Tools

Excel

Word

Job description

Executive Service

Background Check

This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Executive Service

PROSPECTIVE PAYMENT SYSTEM (PPS) ANALYST

Division of TennCare

Fiscal

Nashville, TN

Closing Date: 10/26/2026

Background Check

This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Who We Are And What We Do

TennCare is Tennessee's Medicaid managed care program, serving over 1.4 million Tennesseans, including children, pregnant women, older adults, and individuals with disabilities. With an annual budget exceeding $19.2 billion, TennCare operates under the oversight of the Centers for Medicare and Medicaid Services (CMS). TennCare's mission is to improve the lives of Tennesseans by providing high-quality cost-effective care. To fulfill that purpose, we equip each employee for active participation and empower teams to communicate and worked collaboratively to improve organizational processes in order to make a difference in the lives our members. Because of the positive impact TennCare has on the lives of the most vulnerable Tennesseans, TennCare employees report that their work provides them with a sense of meaning, purpose, and accomplishment. TennCare leadership understands that employees are our most valuable resource and ensures professional and leadership development are a priority for the agency.

Job Overview

The Prospective Payment System (PPS) Analyst is located within TennCare's Fiscal Division. TennCare compensation is equitable and will be based on education and experience for a qualified candidate in accordance with Department of Human Resources (DOHR) policy Provider Reimbursement Team and reports directly to the Director of Provider Reimbursement. The Division of TennCare is dedicated to providing our employees with a hybrid work environment All TennCare positions have a combination of work from home and work in the office, which varies by position, department, and business need. You may review the specific expectations with our hiring team TennCare's fiscal division is responsible for the strategic and day-to-day management of the agency's budget and fiscal processes, ensuring that cost-effective care is delivered in a way that is sustainable for the state budget. The PPS Analyst will work closely with the Director of Provider Reimbursement, the Comptroller of the Treasury's Office, and other agency staff to administer TennCare's Prospective Payment System.

Key Responsibilities

• Assist the Director of Provider Reimbursement with daily oversight of the Prospective Payment System (PPS) for Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC).
• Work closely with the Comptroller of the Treasury's Office to support the administration of the PPS program and address reimbursement issues affecting FQHCs and RHCs.
• Serve as a liaison to the FQHC and RHC provider community by responding to inquiries and providing timely technical assistance related to the PPS program.
• Review and process change-in-scope applications submitted by FQHCs and RHCs.
• Monitor clinic reimbursement data and other fiscal metrics to support ongoing program administration.
• Maintain and update PPS policies, procedures, and related program documentation.
• Produce recurring reports and perform ad hoc analyses related to PPS operations, reimbursement trends, and other fiscal issues.
• Assist with special projects, research, and implementation activities related to provider reimbursement and healthcare finance.The successful candidate will be able to work both independently and collaboratively on a variety of projects and communicate effectively with stakeholders, providers, and agency leadership. The position also requires the ability to research healthcare reimbursement and policy issues, analyze and interpret data, communicate findings clearly, and provide administrative support for provider reimbursement initiatives.

Minimum Qualifications

A master's degree in business, public administration, public health, public policy, or other related field from an accredited college or university;

OR

A bachelor's degree in business, public administration, public health, public policy, or other related field from an accredited college or university with 3+ years of related work experience.

Desirable Qualifications

• Strong analytical skills, with a demonstrated ability to recognize patterns and trends in data and on how to ask and find answers to complex questions and problems.
• Demonstrated problem-solving skills with a track record in creating business processes and improving existing ones.
• Strong computer skills including proficiency in Microsoft Office applications, particularly in Excel & Word.
• Proficiency in oral and written communication skills, with a demonstrated ability for concise and effective communication.
• Strong organizational skills, including the ability to prioritize, multi-task, and manage workload to meet specific time-frames and deadlines

Pursuant to the State of Tennessee's Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State's policy to provide an environment free of discrimination and harassment of an individual because of that person's race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran's status or any other category protected by state and/or federal civil rights laws.