Healthcare Rate Setting Analyst

DHRM • Richmond, VA

1d • Hybrid

About The Position

The Department of Medical Assistance Services (DMAS) is offering a competitive opportunity to serve as the Healthcare Rate Setting Analyst in the Provider Rate Development Division. This position works within the Fee-For-Service Rate Setting Unit and reports to the Healthcare Reimbursement Manager. The role involves serving as a subject matter expert for Medicaid rate development for various provider types (e.g., long-term care, acute care, HCBS) and may provide peer assistance in specialty areas. The position requires working both independently and as part of a team within existing guidelines and policies, and serving as a resource for resolving complex problems. The incumbent is responsible for developing complex and highly technical payment policy analyses for Medicaid and other DMAS-administered programs, and supports the development, review, and evaluation of methods and policies for rate setting and rate development. This position has in-office requirements for meetings and trainings.

Requirements

• Considerable work-related experience and knowledge in developing and completing complex financial analyses in an accurate and timely manner.
• Considerable work-related knowledge and experience researching and solving complex issues and problems including knowledge of healthcare resource research and be able to apply these principles in practice.
• Considerable work-related knowledge and experience in the application of statistics, quantitative methods, qualitative methods, and data science.
• Must be able to translate data into a graphic or visual representation.
• Considerable work-related knowledge and experience in financial analysis, rate development, or actuarial science.
• Considerable work-related knowledge and experience with calculating fiscal impacts of rate and policy changes.
• Considerable experience using Excel, SAS, or SQL for developing complex analysis, aggregating data, drawing conclusions, and developing recommendations.
• Considerable work-related knowledge of state and federal healthcare laws and regulatory processes.
• Considerable experience meeting deadlines.
• Considerable experience with communication with internal and external stakeholders including collaborating with other divisions and stakeholders to ensure proper implementation of business solutions.
• Considerable experience maintaining system protocols in writing by updating processes, procedure documentation, and training materials.

Nice To Haves

• Knowledge of rate setting methodologies used by government and private purchasers of health care services such as DRG, EAPG, RUG, PDPM, and rate models.
• Healthcare rate setting policy analysis, development, and interpretation experience.
• Considerable experience with critical thinking and problem-solving skills, maturity of judgment, and comfort with on-demand decision-making to resolve problems, and to seek support when needed.

Responsibilities

• Serve as a subject matter expert for Medicaid rate development for one or more provider types such as long-term care, acute care, HCBS, etc.
• Provide peer assistance in specialty areas.
• Work both independently and as part of a team within existing guidelines and policies.
• Serve as a resource to others in resolving more complex problems.
• Develop complex and highly technical payment policy analyses for Medicaid and other programs administered by the Department of Medical Assistance Services.
• Serve as support staff in the development, review, and evaluation of methods and policies for rate setting and rate development.
• Conduct regular audits and quality checks to ensure data integrity, troubleshoot data-related issues, and propose solutions.

Benefits

• Telework arrangements are a privilege and may be rescinded at any time based on performance and/or business need.
• The agency reserves the right to modify or terminate a telework arrangement, provided that reasonable notice is given to the employee.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed