Remote Rate-Setting & Cost-Reporting Specialist

Texas Health and Human Services; Austin (TX); On-site; USD 57,000 - 93,000; Full time

Benefits offered by this job

100% paid employee health insurance

Pension plan

Generous time off

Career advancement opportunities

Job summary

The Texas Health and Human Services Commission (HHSC) seeks a Program Specialist VI in Austin to lead complex cost reporting, rate-setting analyses, and reimbursement modeling for non-Medicaid programs within the DFPS Rate Setting team. You will prepare rate calculations, guidance materials, and executive-level summaries for senior leadership.

Under supervision, you will collaborate with finance, program, legal, and IT teams, develop rate-setting procedures, and support audits and legislative

Qualifications

• Graduation from a four-year college or university is required.
• Relevant experience in state government, reimbursement methodology, finance, communications, training, or a related field may substitute on a year-for-year basis.
• Demonstrated experience coordinating a program within a state agency; delivering customer service; developing or providing stakeholder communications; delivering virtual/in-person training; cost reporting processes; or reimbursement methodologies is preferred.

Responsibilities

• Provider Cost Reporting Oversight. (35%)
• Participates in provider cost-reporting activities, including reporting requirements, submission timelines, provider instructions, data collection, review processes, and follow-up.
• Reviews provider cost reports and supporting documentation for completeness, consistency, reasonableness, and compliance with applicable requirements.
• Identifies data-quality concerns, analyzes cost-reporting trends, and coordinates resolution of complex reporting or reimbursement issues.
• Reporting, Communication, and Training. (25%)
• Develops reports, memoranda, summaries, presentations for executive leadership, as well as guidance documents for provider communications, and other materials describing rate-setting analyses, reimbursement methodologies, cost-reporting requirements, and fiscal impacts.
• Provides technical assistance and training to providers, program staff, and other stakeholders on cost reporting, reimbursement concepts, rate-setting processes, and data-submission requirements.
• Responds to complex stakeholder inquiries and explains cost reporting processes, financial analysis, rate-setting functions, and reimbursement information to technical and nontechnical audiences.
• Assists in Rate Setting and Reimbursement Methodology Development. (20%)
• Assists in developing, analyzing, implementing, and maintaining payment rates, reimbursement methodologies, and related financial models for assigned non-Medicaid programs and services.
• Conducts financial, statistical, and policy analyses to support rate recommendations, methodology changes, fiscal impact estimates, and leadership decision-making.
• Assists in the preparation and maintance of rate-setting workpapers, calculation files, assumptions, supporting documentation, and recommendations for review and approval.
• Program Coordination and Policy Support. (15%)
• Collaborates with program, finance, budget, legal, contract, data, and information technology staff to obtain data, implement rate-setting activities, and address reimbursement-related issues.
• Assists with development and maintenance of policies, procedures, desk references, process documentation, and implementation plans related to assigned programs.
• Supports audits, legislative requests, public-information requests, stakeholder meetings, and other provider finance initiatives.
• Other Duties as Assigned. (5%)
• Performs related work and special projects as assigned to support Provider Finance and LTSS operational priorities.

Skills

Financial analysis

Data analysis

Rate setting

Policy analysis

Stakeholder communication

Education

Bachelor's degree

Tools

Microsoft Excel

Word

PowerPoint

Outlook

Job description

The Texas Health and Human Services Commission (HHSC) seeks a Program Specialist VI in Austin to lead complex cost reporting, rate-setting analyses, and reimbursement modeling for non-Medicaid programs within the DFPS Rate Setting team. You will prepare rate calculations, guidance materials, and executive-level summaries for senior leadership.

Under supervision, you will collaborate with finance, program, legal, and IT teams, develop rate-setting procedures, and support audits and legislative