Reimbursement Analyst

Date Posted: Sep 4, 2024

Requisition ID: 449020

Location:

Indianapolis, IN, US, 46204

Begin a fulfilling career with the State of Indiana by joining one of the largest employers in the state, offering a diverse range of opportunities across 60+ agencies. At the state, you'll find competitive compensation, a robust benefits package and a commitment to work-life balance. Most importantly, you'll have the chance to make a real and measurable impact on the lives of Hoosiers across Indiana.

At the State of Indiana, we don’t just talk about diversity and inclusion—we make it our goal to create a welcoming, accessible, and equitable workplace with a workforce that is representative of Indiana's population. As a proud equal opportunity employer, reasonable accommodations may be available to enable individuals with disabilities to complete the application and interview process as well as perform the essential functions of a role.

About the Family & Social Services Administration (FSSA):

The Office of Medicaid Policy and Planning (OMPP) is a division within the Family and Social Services Administration, which receives around 18 percent of the state's budget to ensure vital health care coverage to approximately 1 in 4 Hoosiers. OMPP strives to build programs and processes that enable Hoosiers to live in fully engaged communities and reach their greatest emotional, mental, and physical well-being. Our mission is to support individual and community well-being with effective and efficient programs, remarkable collaborations, measurable impact on individuals and communities, and an energized staff that is fully engaged with this mission.

Salary Statement:

The salary for this position traditionally starts at $59,800.00 but may be commensurate with education or work experience.

Role Overview:

The Reimbursement Analyst is the subject matter expert on Long Term Care (LTC) reimbursement for nursing facilities to ensure Medicaid reimbursement rates and payments are established following the State Plan, state and federal laws, and regulations. You will stay abreast of new initiatives and maintain ongoing unit operations, including Upper Payment Limit (UPL) calculations, Change of Ownership (CHOW) documentation, state plan amendment submissions, LTC provider appeals, Minimum Data Set (MDS) Reviews, and training. The ideal candidate will have Medicaid-related experience with specialized knowledge of Medicaid policies and procedures concerning long-term care reimbursement, knowledge of related federal and state laws and regulations, and proficiency in Microsoft Excel.

A Day in the Life:

The essential functions of this role are as follows:

• Analyze, review, approve, and submit all quarterly and final Upper Payment Limit (UPL) expenditure request calculations.

• Facilitates integration and coordination with other areas in OMPP, specifically home health, hospice, and acute care reimbursement and policy.

• Recommend changes to nursing facility reimbursement based on changing landscape of the long-term care industry, as well as, state and federal regulations.

• Assist with other reimbursement projects as is necessary to fulfill agency and state objectives.

• Review nursing facility rates set by rate setting contractor.

• Perform contract monitoring of the Long Term Care section of the Rate Setting contract.

• Analyze, review, and approve incoming change of ownership (CHOWs) involving non-state government-owned (NSGO) entities.

• Maintain electronic database of all NSGO CHOWs, including but not limited to date of receipt, new owner, management company, effective date, and date of approval of the CHOW.

• Review, validate, and process incoming appeals, routing them to the proper subject matter expert, contractor, and FSSA Legal.

• Maintain an electronic log of all provider appeals (excluding program integrity appeals).

  The job profile is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Other duties, responsibilities, and activities may change or be assigned at any time.

What You'll Need for Success:

Credentials:

• a Bachelor’s Degree with 5+ years of experience, or

• an Associate’s Degree with 7+ years of experience, or

• at least 9+ years of experience applying the below, outlined knowledge, skills, and abilities in a similar role.

  Additional qualifications:

• Specialized knowledge in program subject matter obtained through experience and/or education.

• Extensive knowledge of provider agencies and their programs and services.

• Extensive knowledge of all source materials and references including federal and state laws governing the programs.

• Ability to develop and implement new principles and policies and discern any far-reaching implications.

• Ability to present to internal and external customers, the public, government officials, and other stakeholders.

• Ability to analyze information and evaluate results to choose the best solution and solve problems.

• Ability to work effectively with a wide variety of stakeholders.

• Ability to prepare monthly finance and accounting reports to maintain program budget and grants.

• Ability to delegate work, set clear direction, and manage workflow.

• Ability to effectively give feedback, provide guidance or corrective action, coach, and develop employee skillsets.

Supervisory Responsibilities/Direct Reports:

This role may serve as a team lead for an assigned work group.

Benefits of Employment with the State of Indiana:

The State of Indiana offers a comprehensive benefits package for full-time employees which includes:

• Three (3) medical plan options (including RX coverage) as well as vision and dental plans

• Wellness Rewards Program: Complete wellness activities to earn gift card rewards

• Health savings account, which includes bi-weekly state contribution

• Flexible work scheduling options, including the potential for hybrid remote work for employees whose work may be performed outside state facilities

• Deferred compensation 457B account (similar to 401k plan) with employer match

• Two (2) fully-funded pension plan options

• A robust, comprehensive program of leave policies covering a variety of employee needs, including but not limited to:

• 150 hours of paid new parent leave

• Up to 15 hours of paid community service leave

• Combined 180 hours of paid vacation, personal, and sick leave time off

• 12 paid holidays, 14 on election years

• Education Reimbursement Program

• Group life insurance

• Referral Bonus program

• Employee assistance program that allows for covered behavioral health visits

• Qualified employer for the Public Service Loan Forgiveness Program

• Free Parking for most positions

• Free LinkedIn Learning access

  Equal Employment Opportunity:

  The State of Indiana is an Equal Opportunity Employer and is committed to recruiting, selecting, developing, and promoting employees based on individual ability and job performance. Our policy is to provide equal employment opportunity to all people in all aspects of employer-employee relations without discrimination because of race, color, creed, religion, sex, national origin, ancestry, age, sexual orientation, gender identity, physical or mental disability, or veteran status. We will comply with the spirit as well as the letter of all applicable state and federal laws.

  If you are a qualified individual with a disability and require reasonable accommodations to complete this application, you can request assistance by contacting the Indiana State Personnel Department at [email protected] .

  The State of Indiana has established a culture that welcomes equity, inclusion, and opportunity for all employees and applicants. We encourage you to apply if you feel you have the transferrable skills to be successful in this position and we look forward to reviewing your application.

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