- Hourly / - BiWeekly /
- Monthly / $46,942.00-$74,933.00 Yearly
Health Services Rate Analyst I is the intermediate level of work setting rates hospitals charge for health services and auditing hospital records for compliance with established rates. Employees in this classification do not supervise.
Employees in this classification receive moderate supervision from a Health Services Rate Analyst Supervisor.
Health Services Rate Analyst Trainee, Health Services Rate Analyst I and Health Services Rate Analyst II are differentiated on the basis of degree of supervisory control exercised by the supervisor over these employees. The Health Services Rate Analyst Trainee learns to perform duties under close supervision, the Health Services Rate Analyst I performs duties under close supervision at times and under general supervision at other times depending on the complexity of the specific duty being performed and the Health Services Rate Analyst II performs the full range of duties under general supervision.
Reviews financial data from hospitals for completeness, accuracy, validity and adequacy for rate setting purposes;
Determines the scope and nature of analysis of financial data required to set reasonable rates to be charged for health services;
Performs calculations to develop inflation factors, inpatient rate changes, price leveling factors and case mix adjustments on inflation adjustments;
Applies appropriate rate setting methodologies required for inflation adjustments, guaranteed inpatient revenue adjustments and whole or partial rate reviews;
Modifies rate setting methodologies for special factors or circumstances such as rate reductions and changes in intensity factors;
Prepares manual and computerized work papers to document the rate setting process;
Discusses proposed rates with hospital officials, physicians and health insurance officials to gather information and explain the basis of rate proposals;
Presents empirical evidence summarized into staff recommendations to the Health Services Cost Review Commission (HSCRC) on the effectiveness and efficiency of proposed rates;
Prepares testimony and provides background information for presentation at formal and informal hearings to explain and defend rate reviews and analyses;
Audits annual financial statements of hospitals;
Assists with proposed spend downs for hospitals to bring health services rates down to reasonable levels;
Interprets and applies HSCRC regulations and policies in the review of hospital rate proposals;
Performs other related duties.
Knowledge of generally accepted accounting principles, theory, procedures and methods;
Knowledge of generally accepted auditing standards;
Knowledge of cost accounting principles, theory, procedures and methods as related to the provision of health services;
Knowledge of business administration and management practices;
Knowledge of HSCRC rate setting methodologies;
Skill in analyzing and interpreting hospital financial reports and statements;
Skill in using computerized fiscal applications and software;
Skill in applying health services rate setting principles and methodologies;
Skill in modifying health services rate setting methodologies as needed to meet unusual circumstances;
Skill in documenting and defending HSCRC rate setting proposals;
Ability to communicate effectively;
Ability to establish and maintain effective working relationships with HSCRC staff, accountants, auditors, data processing staff, attorneys, hospital officials, physicians and representatives of health insurance companies.
Education: A bachelor's degree in accounting, finance, economics, hospital administration or health care administration from an accredited college or university.
Experience: One year of experience reviewing, analyzing or negotiating rates hospitals charge for medical services and auditing hospital records for compliance with established rates.
1. Additional experience reviewing, analyzing or negotiating rates hospitals charge for medical services and auditing hospital records for compliance with established rates may be substituted for the required college education on a year for year basis.
2. Possession of a master's degree in accounting, finance, economics, hospital administration or health care administration from an accredited college or university may be substituted for one year of the required experience.