Healthcare Reimbursement Manager

State of Virginia•Richmond, VA

48d•Onsite

About The Position

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as the Healthcare Reimbursement Manager. The selected competitive candidate will provide exceptional delivery of services to the Provider Rate Development Division. Job responsibilities will include, but are not limited to: The Healthcare Reimbursement Manager leads the Capitation Rate Setting team in the Provider Rate Development Division, overseeing all activities related to the calculation, validation, and submission of actuarially sound Medicaid and CHIP capitation rates for the Commonwealth of Virginia. This role ensures full compliance with federal and state requirements, effective management of actuarial contractors, and the delivery of timely, high-quality financial analysis to agency leadership and stakeholders. By leveraging advanced data analysis, actuarial expertise, and proactive stakeholder collaboration, the position supports the financial sustainability of contracted Managed Care Organizations (MCOs) and enhances the efficiency of provider reimbursement processes. The role directly addresses complex challenges with sound actuarial judgment to safeguard public resources, maintain public trust, and advance DMAS's mission to provide high-quality health care coverage for Virginians. The business needs for this position have in office requirements to include but are not limited to attending in-person meetings and attending internal and external stakeholder's meetings. Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high quality health care coverage. DMAS wants talented individuals who can align their experience with the mission of the agency and its core values - service, collaboration, trust, problem solving and adaptability. At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise

Requirements

Must be an Associate of the Society of Actuaries (ASA).
Experience in finance, specifically in analyzing complex datasets to draw actionable conclusions and recommendations, as well as preparing detailed reports.
Considerable knowledge of reimbursement and capitation rate-setting methodologies utilized by government agencies and private purchasers of healthcare services.
Considerable experience in designing and implementing processes and procedures for advanced financial analysis, including statistical and quantitative methods.
Considerable experience conducting in-depth research on public policy issues, with a focus on health policy and budget analysis, and interpret findings to inform decision-making.
Considerable experience managing capitation reimbursement activities, including rate-setting and financial modeling processes.
Considerable experience using Microsoft Excel for healthcare financial analysis, project management, and aggregating large datasets for reporting purposes.
Considerable experience interpreting and applying state and/or federal regulations to the development of financial models and actuarial analyses for governing managed care programs.
Considerable experience meeting stringent deadlines while maintaining accuracy and attention to detail in deliverables.
Considerable experience communicating effectively with internal and external stakeholders, including demonstrated ability to prepare and present written and oral reports on complex financial or policy issues.

Nice To Haves

Experience in database programming (SAS or similar) to extract and analyze data.
Member of the American Academy of Actuaries (MAAA).

Responsibilities

The Healthcare Reimbursement Manager leads the Capitation Rate Setting team in the Provider Rate Development Division, overseeing all activities related to the calculation, validation, and submission of actuarially sound Medicaid and CHIP capitation rates for the Commonwealth of Virginia.
This role ensures full compliance with federal and state requirements, effective management of actuarial contractors, and the delivery of timely, high-quality financial analysis to agency leadership and stakeholders.
By leveraging advanced data analysis, actuarial expertise, and proactive stakeholder collaboration, the position supports the financial sustainability of contracted Managed Care Organizations (MCOs) and enhances the efficiency of provider reimbursement processes.
The role directly addresses complex challenges with sound actuarial judgment to safeguard public resources, maintain public trust, and advance DMAS's mission to provide high-quality health care coverage for Virginians.
The business needs for this position have in office requirements to include but are not limited to attending in-person meetings and attending internal and external stakeholder's meetings.

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