State of Maryland

A 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 other positions.

Employees in this classification receive general supervision from a Health Services Rate Analyst Supervisor or other designated administrator.

Positions in this classification are evaluated by using the classification job evaluation methodology.  The use of this method involves comparing the assigned duties and responsibilities of a position to the job criteria found in the Nature of Work and Examples of Work sections of the class specification.

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 and responsibilities under general supervision.  The Health Services Rate Analyst, Advanced is differentiated from the Health Services Rate Analyst Supervisor that the Health Services Rate Analyst Supervisor has 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;

Drafts, in conjunction with the Hearing Officer and the Commission's Attorney, proposed decisions on contested issues;

Responds to inquiries from the full Commission regarding proposed decisions;

Prepares, in conjunction with the Commission's Attorney, 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.

Experience: Eight years of experience reviewing, analyzing or negotiating rates hospitals charge for medical services and auditing hospital records for compliance with established rates.

Notes:

1. Candidates may substitute the possession of a Bachelor's degree in accounting, finance, economics, hospital administration or health care administration from an accredited college or university and four years of experience reviewing, analyzing or negotiating rates hospitals charge for medical services and auditing hospital records for compliance with established rates for the required experience.

2. Candidates may substitute the possession of a Master's degree in accounting, finance, economics, hospital administration or health care administration from an accredited college or university for five years of the required experience.

Class specifications are broad descriptions covering groups of positions used by various State departments and agencies. Position descriptions maintained by the using department or agency specifically address the essential job functions of each position.

This is a Skilled Service classification in the State Personnel Management System.  All positions in this classification are Skilled Service positions. Some positions in Skilled Service classifications may be designated Special Appointment in accordance with the State Personnel and Pensions Article, Section 6-405, Annotated Code of Maryland.

This classification is assigned to Bargaining Unit G, Engineering, Scientific and Administrative Professionals classes. As provided by State Personnel and Pensions Article, Section 3-102, special appointment, temporary, contractual, supervisory, managerial and confidential employees are excluded from collective bargaining. Additionally, certain executive branch agencies are exempt from collective bargaining and all positions in those agencies are excluded from collective bargaining.