DVHA Rate Setting Manager

State of Vermont•Waterbury, VT

8d•Hybrid

About The Position

Join our team to lead a group of reimbursement professionals and oversee a portfolio of Medicaid reimbursement methodologies! The Department of Vermont Health Access is seeking an experienced professional to lead its Reimbursement unit. Have the work/life balance you need with a Monday-Friday schedule and a supportive hybrid work environment. The Reimbursement unit plays a critical role in establishing, implementing, and maintaining fee-for-service payment methodologies across the Medicaid program and in partnership with departments within the Agency of Human Services.

Requirements

Practical experience with health insurer payment methodologies and organizational operations.
Strong analytic skills.
Leadership experience.
Excellent written and verbal communication skills to represent methodologies and annual updates in leadership forums and with other key stakeholders as needed.
Strong competencies in federal regulations and medical coding.
Ability to operate independently in addition to working collaboratively with various partners at a professional level.
Bachelor's degree in accounting, public or business administration, or a related field AND four (4) years or more of experience at a professional level in health policy, health services research, economics, accounting, auditing, or public or business administration, INCLUDING two (2) years in a health care-related role and two (2) years in a supervisory or policy development role.
Current or past licensure as a CPA AND four (4) years or more of experience at a professional level in health policy, health services research, economics, accounting, auditing, or public or business administration, INCLUDING two (2) years in a health care-related role and two (2) years in a supervisory or policy development role.
Master's degree in accounting, public administration, law, or a field related to health care AND two (2) years or more at a professional level in health policy, health services research, economics, accounting, auditing, or public or business administration.

Responsibilities

Manages a variety of Medicaid fee schedules and other methodologies, including but not limited to: Inpatient Prospective Payment System (IPPS), Outpatient Prospective Payment System (OPPS), Medicaid Professional fee schedule, Clinical Laboratory fee schedule, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule, Dental fee schedule, and Various methodologies supporting Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) reimbursement.
General oversight of activities related to provider tax calculations and Graduate Medical Education (GME) payment calculations.
Maintaining current and accurate information within policy documents such as the Medicaid State Plan and provider manuals.
Analysis of annual updates to relevant federal and state regulations.
Coordination with appropriate internal and external partners to implement annual updates in a timely manner.