Prospective System; Pps) Analyst

This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Tenn Care is Tennessee's Medicaid managed care program, serving over 1.4 million Tennesseans, including children, pregnant women, older adults, and individuals with disabilities. With an annual budget exceeding $19.2 billion, Tenn Care operates under the oversight of the Centers for Medicare and Medicaid Services (CMS). Tenn Care's mission is to improve the lives of Tennesseans by providing high-quality cost-effective care. To fulfill that purpose, we equip each employee for active participation and empower teams to communicate and worked collaboratively to improve organizational processes in order to make a difference in the lives our members.

Because of the positive impact Tenn Care has on the lives of the most vulnerable Tennesseans, Tenn Care employees report that their work provides them with a sense of meaning, purpose, and accomplishment. Tenn Care leadership understands that employees are our most valuable resource and ensures professional and leadership development are a priority for the agency.

The Prospective Payment System (PPS) Analyst is located within Tenn Care's Fiscal Division. Tenn Care compensation is equitable and will be based on education and experience for a qualified candidate in accordance with Department of Human Resources (DOHR) policy Provider Reimbursement Team and reports directly to the Director of Provider Reimbursement. The Division of Tenn Care is dedicated to providing our employees with a hybrid work environment All Tenn Care positions have a combination of work from home and work in the office, which varies by position, department, and business need.

You may review the specific expectations with our hiring team Tenn Care's fiscal division is responsible for the strategic and day-to-day management of the agency's budget and fiscal processes, ensuring that cost-effective care is delivered in a way that is sustainable for the state budget. The PPS Analyst will work closely with the Director of Provider Reimbursement, the Comptroller of the Treasury's Office, and other agency staff to administer Tenn Care's Prospective Payment System.

• Assist the Director of Provider Reimbursement with daily oversight of the Prospective Payment System (PPS) for Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC).
• Work closely with the Comptroller of the Treasury's Office to support the administration of the PPS program and address reimbursement issues affecting FQHCs and RHCs.
• Serve as a liaison to the FQHC and RHC provider community by responding to inquiries and providing timely technical assistance related to the PPS program.
• Review and process change-in-scope applications submitted by FQHCs and RHCs.
• Monitor clinic reimbursement data and other fiscal metrics to support ongoing program administration.
• Maintain and update PPS policies, procedures, and related program documentation.
• Produce recurring reports and perform ad hoc analyses related to PPS operations, reimbursement trends, and other fiscal issues.
• Assist with special projects, research, and implementation activities related to provider reimbursement and healthcare finance.
  
  The successful candidate will be able to work both independently and collaboratively on a variety of projects and communicate effectively with stakeholders, providers, and agency leadership. The position also requires the ability to research healthcare reimbursement and policy issues, analyze and interpret data, communicate findings clearly, and provide administrative support for provider reimbursement initiatives.

A master's degree in business, public administration, public health, public policy, or other related field from an accredited college or university;

OR

A bachelor's degree in business, public administration, public health, public policy, or other related field from an accredited college or university with 3+ years of related work experience.