What are the responsibilities and job description for the Reimbursement Analyst position at DC Department of Human Resources?
When you become a member of Team DHCF (Department of Health Care Finance), the state Medicaid agency for the District of Columbia, you join our "Mission Possible!" We work every day, in concert with various District government agencies, to streamline access to comprehensive, affordable and quality healthcare services for District residents. Whatever your position within our agency, you will positively impact beneficiaries, their families and their future! We invite you to bring your skills, your experience and your passion to a job that makes a difference!
Job Summary
This position is located within the Department of Health Care Finance (DHCF), Office of the Director, Office of Rates, Reimbursements, and Financial Analysis (ORRFA). This incumbent serves as a Reimbursement Analyst working closely with external health care providers in establishing rates for services provided.
Duties And Responsibilities
Provides in-depth advice to the Deputy Director and DHCF management on rate setting and reimbursement actions, including an analysis of problems encounters and recommendation; calculates, reviews, and monitors reimbursements methodology payment rates for the District of Columbia. Establishes a system to track and evaluates overpayments; initiates and coordinates recovery efforts including the evaluation of provider’s documentation to develop repayment plan. Applies reimbursement formulas
Applies reimbursement formulas to calculate federal/local share in the funding of providers. Participates in project teams involved in reviewing pending District and federal legislation affecting DHCF programs related to payment and rate setting. Develops Ad hoc updates to the fee schedule (e.g. external and internal requests to add codes, change pricing, or change authorizations or units); develops manual pricing for codes “covered” and not priced on the fee schedule. Works with consultants to update the annual Upper Payment Limit (UPL) demonstrations.
Qualifications And Education
Specialized Experience – Experience that equipped the applicant with the particular knowledge, skills and abilities to perform successfully the duties of the position, and this is typically in or related to the work of the position to be filled. To be creditable, at least one (1) year of specialized experience must have been equivalent to at least the next lower grade level in the normal line of progression.
Licenses and Certifications
None.
Working Conditions/Environment
The work is performed in a typical office setting.
Other Significant Facts
Tour of Duty: Monday – Friday; 8:15 am - 4:45 pm
Pay Plan, Series, and Grade: CS-301-14
Promotion Potential: No known promotion potential.
Collective Bargaining Unit (Union): This position is NOT represented by a collective bargaining unit.
Position Designation: This position has been designated as security sensitive therefore the incumbent of this position will be subject to enhanced suitability screening pursuant to Chapter 4 of DC Personnel Regulations, Suitability and as such, incumbents of this position shall be subject to criminal background checks, background investigations, and mandatory drug and alcohol testing, as applicable.
Residency Preference: Applicants claiming “Residency Preference” will be required to maintain residency in the District of Columbia for a minimum of seven (7) years. Failure to do so may result in forfeiture of employment.
EEO Statement: The District of Columbia Government does not discriminate or retaliate in employment on the basis of race, color, religion, sex, pregnancy, gender identity and expression, national origin, family responsibilities, political affiliation, sexual orientation, marital status, homeless status, disability, genetic information, age, membership in an employee organization, participation in a legally protected activity, parental status, matriculation, personal appearance, credit information, status as a victim or family member of a victim of domestic violence, sexual offense, or stalking, military service, or other non-merit factor.
Job Summary
This position is located within the Department of Health Care Finance (DHCF), Office of the Director, Office of Rates, Reimbursements, and Financial Analysis (ORRFA). This incumbent serves as a Reimbursement Analyst working closely with external health care providers in establishing rates for services provided.
Duties And Responsibilities
Provides in-depth advice to the Deputy Director and DHCF management on rate setting and reimbursement actions, including an analysis of problems encounters and recommendation; calculates, reviews, and monitors reimbursements methodology payment rates for the District of Columbia. Establishes a system to track and evaluates overpayments; initiates and coordinates recovery efforts including the evaluation of provider’s documentation to develop repayment plan. Applies reimbursement formulas
Applies reimbursement formulas to calculate federal/local share in the funding of providers. Participates in project teams involved in reviewing pending District and federal legislation affecting DHCF programs related to payment and rate setting. Develops Ad hoc updates to the fee schedule (e.g. external and internal requests to add codes, change pricing, or change authorizations or units); develops manual pricing for codes “covered” and not priced on the fee schedule. Works with consultants to update the annual Upper Payment Limit (UPL) demonstrations.
Qualifications And Education
Specialized Experience – Experience that equipped the applicant with the particular knowledge, skills and abilities to perform successfully the duties of the position, and this is typically in or related to the work of the position to be filled. To be creditable, at least one (1) year of specialized experience must have been equivalent to at least the next lower grade level in the normal line of progression.
Licenses and Certifications
None.
Working Conditions/Environment
The work is performed in a typical office setting.
Other Significant Facts
Tour of Duty: Monday – Friday; 8:15 am - 4:45 pm
Pay Plan, Series, and Grade: CS-301-14
Promotion Potential: No known promotion potential.
Collective Bargaining Unit (Union): This position is NOT represented by a collective bargaining unit.
Position Designation: This position has been designated as security sensitive therefore the incumbent of this position will be subject to enhanced suitability screening pursuant to Chapter 4 of DC Personnel Regulations, Suitability and as such, incumbents of this position shall be subject to criminal background checks, background investigations, and mandatory drug and alcohol testing, as applicable.
Residency Preference: Applicants claiming “Residency Preference” will be required to maintain residency in the District of Columbia for a minimum of seven (7) years. Failure to do so may result in forfeiture of employment.
EEO Statement: The District of Columbia Government does not discriminate or retaliate in employment on the basis of race, color, religion, sex, pregnancy, gender identity and expression, national origin, family responsibilities, political affiliation, sexual orientation, marital status, homeless status, disability, genetic information, age, membership in an employee organization, participation in a legally protected activity, parental status, matriculation, personal appearance, credit information, status as a victim or family member of a victim of domestic violence, sexual offense, or stalking, military service, or other non-merit factor.