Healthcare Rate Setting Analyst

Virginia Information Technologies Agency • Richmond, VA

2d • 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). The position requires developing complex and highly technical payment policy analyses for Medicaid and other DMAS-administered programs, and supporting the development, review, and evaluation of rate-setting methods and policies. The business needs for this position include in-office requirements for meetings and trainings. DMAS aims to improve the health and well-being of Virginians through high-quality healthcare coverage and seeks talented individuals who align with the agency's mission and core values: service, collaboration, trust, problem-solving, and adaptability.

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.
• Support 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

• The Department of Medical Assistance Services (DMAS) is a V3 certified state agency that provides hiring preference to veterans and members of the reserves and/or National Guard in support of executive order 29, (2010).

What This Job Offers

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