- Hourly / - BiWeekly /
- Monthly / $53,214.00-$85,398.00 Yearly
Health Services Rate Analyst, Advanced is the advanced level of work setting rates hospitals charge for health services and auditing hospital records for compliance with established rates. Employees in this classification perform advanced duties as rate setting technical advisor to the Health Services Cost Review Commission (HSCRC) during the periodic complete review of contested hospital rate cases. Employees in this classification do not supervise.
Employees in this classification receive general supervision from a Health Services Rate Analyst Supervisor or other designated administrator.
The Health Services Rate Analyst, Advanced is differentiated from the Health Services Rate Analyst II in that the Health Services Rate Analyst, Advanced performs advanced duties as rate setting technical advisor to the HSCRC during the periodic complete review of contested hospital rate cases, while the Health Services Rate Analyst II performs the full range of duties under general supervision. The Health Services Rate Analyst, Advanced is differentiated from the Health Services Rate Analyst Supervisor on the basis of supervisory responsibility. The Health Services Rate Analyst Supervisor has full supervisory responsibility for lower-level Health Services Rate Analysts.
Reviews, independent from the HSCRC staff, hospital full rate applications and HSCRC staff recommendations coming before the Commission;
Reviews pre-filed testimony from all parties before formal hearings;
Examines, identifies and formally delineates contested issues of cases with the Hearing Officer and the Commission's attorney;
Interprets HSCRC staff recommendations in relation to the long-term impact on HSCRC laws, regulations or policies;
Advises Commissioners during formal hearings regarding any technical questions on rate setting methods and techniques;
In conjunction with the Hearing Officer and the Commission's attorney, drafts proposed decisions on contested issues;
Responds to inquiries from the full Commission regarding proposed decisions;
In conjunction with the Commission's attorney, prepares final decisions on contested rate cases after all Commission concerns have been addressed;
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;
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 workpapers 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 presented to the HSCRC on the effectiveness and efficiency of proposed rates;
Prepares testimony and provides background information for presentation at formal and informal hearings in order 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 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 service 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.
Ability to function independently as the rate setting technical advisor to the HSCRC during the review of contested hospital rate cases.
Education: A bachelor's degree in accounting, finance, economics, hospital administration or health care administration from an accredited college or university.
Experience: Four years 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