Financial Analyst Provider Reimbursement (Durham)

San Mateo County in Durham, NC

  • Industry: Financial Services - Banking/Investment/Finance - Financial Analyst/Examiner
  • Type: Full Time
  • $100,735.00 - 168,500.00
position filled
Description of Work **This position is exempt from the State Human Resources Act**
Position Summary
The Financial Analyst is primarily responsible for establishing and coordinating the rate setting and reimbursement needs for Non-Facility services which includes dental, durable medical equipment, home infusion therapy, optical, orthotics & prosthetics, podiatry, optometrist, and chiropractor. This position performs complex work and in-depth financial analysis on assigned providers to determine payment rates. This includes comparative analysis with prior years' health program cost information as well as national and industry data.

Job Specific Responsibilities
  • Compile, monitor and analyze data for the purpose of setting reasonable and adequate rates, controlling costs, and evaluating the strengths and weaknesses of the reimbursement methodologies
  • Provide responses and training as needed to respective providers as well as follow-up on inquiries of the provider as needed
  • Responsible for setting payment rates for individual providers and for determining annual fee schedule changes in accordance with the Division's reimbursement plans and federal regulations
  • Ensure all appropriate changes are made in NC Tracks to accommodate new rates and coordinate with other sections of DMA to ensure changes are communicated to others who may be impacted by the change
  • Develop and improve upon the reimbursement plans and methods, and prepare sate plan amendments as needed
  • Determine payment rates for new providers based on budget reviews
  • Study alternative reimbursement systems in order to develop and implement reimbursement systems that are the most effective and efficient in providing appropriate funding support within budget constraints

  • Salary Grade: GN14; Position #:60042545
    Salaries are based on education, experience, equity and budget

    The North Carolina Medicaid and NC Health Choice programs (NC Medicaid), managed by the Division of Health Benefits (DHB), helps North Carolinians improve their health and well-being by providing access to services and supports for low-income parents, children, seniors, people with intellectual / developmental disabilities, behavioral health needs or substance use disorders. With a budget of more than $14 billion per fiscal year, Medicaid ensures that 69,000 enrolled providers are reimbursed for delivering covered services to more than two million beneficiaries.

    On Sept. 23, 2015, the North Carolina General Assembly passed Session Law 2015-245, as amended, directing NCDHHS and DHB to lead the transformation of the Medicaid and NC Health Choice programs from a predominantly fee-for-service delivery system to managed care. Knowledge, Skills and Abilities / Competencies

    To receive credit for all of your work history and credentials, you must list the information on the application form. Any information listed under the text resume section or on an attachment will not be considered for qualifying credit. Qualified applicants must document on the application that they possess all of the following:

  • Demonstrated ability to analyze and correct financial problems, prepare interpretive or analytical accounting statements and reports, and interpret and apply fiscal regulations
  • In-depth knowledge of accounting theories and principles
  • Excellent verbal and written communication skills, and proven ability to work with different levels of management
  • Demonstrated ability to plan and organize work, and be very flexible and adaptable to continually changing priorities
  • Establish and maintain effective working relationships with the public and with department personnel
  • Strong analytical and problem-solving skills
  • Highly proficient in Microsoft Word and Excel
  • Proven ability to generate reports using Excel
  • Management prefers
  • Rate setting and analysis experience
  • CPA and/or MBA
  • Medicaid, Medicare, and/or health insurance experience
  • NCTracks system experience
  • Minimum Education and Experience Requirements

    Bachelor s degree in accounting, banking, finance, business administration, economics, or related discipline from an accredited institution and 1 year of directly related experience or an equivalent combination of education and experience.
    Degrees must be from appropriately accredited colleges or universities

    Supplemental and Contact Information

    The North Carolina Department of Health and Human Services is an Equal Opportunity Employer.

    Pre-Employment criminal background checks are required for all positions with the Division of Health Benefits.

    Due to the volume of applications received, we are unable to provide information regarding the status of your application over the phone. To check the status of your application, please log in to your account . You will either receive a call to schedule an interview or an email notifying you when the job has been filled.

    For technical issues with your application, please call the NeoGov Help Line at 855-###-####. Applicants will be communicated with via email only for updates on the status of their application. If there are any questions about this posting other than your application status, please contact HR at 919-###-####.


    Associated topics: analyse, business analyst, consult, financial reporting analyst, forecasting, government, investment banking, law, market, refinement

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