MEDICAID REIMBURSEMENT ANALYST 23503

5/2/88 B

CLASS CONCEPT/FUNCTION

This is an advanced level class in a single class, analytical accounting series. Positions in this class are responsible for analyzing diverse and complex expense reports in order to calculate prospective payment rates and allowable costs for health care institutions to be reimbursed by Medicaid.

DISTINGUISHING FEATURES OF THE WORK

Complexity of Work: Performs work of considerable difficulty. Evaluates the completeness, allowability and reasonableness of expenses claimed in cost reporting packages including financial statements, general ledger trial balances, construction costs, debt financial instruments, amortization schedules, leases, partnership agreements, capital-related costs and depreciation schedules. Calculates lump sum settlements payable to or due from providers of health care services. Recommends the targets and scope for field audits of health care institutions. Analyzes Medicaid and Medicare field audit findings to calculate cost adjustments for reimbursement. Designs repayment schedules or recommends reduction of reimbursement rates to recoup funds due from providers. Presents the position to the Medicaid program regarding a provider's reimbursement before appeal hearings or in court.

Supervision Given: Supervision is typically not a factor.

Supervision Received: General direction is received from a Medicaid Reimbursement Audit Supervisor. Completed work is reviewed in terms of completing cost settlement and rate setting objectives.

Scope: Work affects the financial status of health care institutions and Medicaid program.

Impact of Actions: Ineffective decisions could result in misappropriation of funds and incorrect payments or reimbursements for services.

Personal Contacts: Frequent contact with health care institution's administrators, lawyers and accountants regarding timely cost report filing and regarding reimbursement issues including appeal procedures. Represents the Medicaid program regarding reimbursement issues before appeal hearings or in court.

KNOWLEDGES, SKILLS AND ABILITIES:

Knowledge: Considerable knowledge of principles and technical methods of professional auditing and of the financial analysis of business organizations. Considerable knowledge of business accounting practices. Knowledge of regulatory compliance processes.

Skills: None identified for this class.

Abilities: Demonstrated ability to assess complex financial analysis and audit issues; to accomplish audit program objectives; to interpret complex statutes and regulations, Generally Accepted Accounting Principles and Generally Accepted Auditing Standards.

QUALIFICATIONS GUIDE*

Licenses or Certifications: None.

Education or Training: Graduation from an accredited college or university with course work in accounting, finance, or a related field.

Level and Type of Experience: Experience in auditing or accounting.

An equivalent combination of training and experience indicating possession of the preceding knowledges and abilities may substitute for this education and experience.

CLASS HISTORY

This is a new class established in September, 1986.