Medicaid Operations Administrator

State of Vermont•Waterbury, VT

2d•Hybrid

About The Position

The Medicaid Operations Administrator directs and coordinates annual rate updates and major policy changes to existing or new payment methodologies for programs administered by the Department of Vermont Health Access (DVHA). The role is part of DVHA’s Reimbursement Unit and supports reimbursement work affecting Vermonters, including financial and policy analysis, provider payment methodologies, and coordination with internal and external partners. The position involves regular interaction with Vermont hospitals, other state departments, the State’s fiscal agent, providers, and state and federal officials. Duties are largely performed in a standard office setting, with predictable field travel requiring private transportation. The role may require work outside the normal workday and workweek, and meetings may involve stressful situations. The position offers a Monday–Friday schedule and a supportive hybrid work environment.

Requirements

Meet one of the following minimum qualification pathways: master’s degree coursework in a human services or administration field and at least one year of experience in health, welfare, mental health, or social services; bachelor’s degree and at least two years of such experience; two years of full-time college coursework or an associate degree and at least four years of such experience; or at least six years of such experience.
Pass any background investigation applicable to the position.
Have private means of transportation available for predictable field travel.

Nice To Haves

College degree in human services, business administration, or public administration.
Strong financial analysis, data gathering, manipulation, and review skills, including evaluating and comparing financial and medical claims data.
Proficiency in Microsoft Office, particularly Excel.
Strong communication skills and ability to collaborate effectively with diverse individuals and organizations.
Experience with healthcare claims processing and/or healthcare financial analysis.
Familiarity with medical coding.

Responsibilities

Direct annual updates to Medicaid fee schedules and other payment methodologies, including IPPS, OPPS, professional, clinical laboratory, DMEPOS, dental, FQHC, and RHC reimbursement.
Gather data, conduct fiscal review and analysis, model rates, and calculate fiscal impacts for rate and fee schedule updates.
Gather data and calculate annual supplemental hospital payments for the Disproportionate Share Hospital program, coordinating with Vermont hospitals, other departments, and the fiscal agent.
Review and complete timely filing requests.
Interpret existing federal and state policies and procedures.
Evaluate and analyze the programmatic impact of proposed regulatory and policy changes.
Review and prepare updates to the Medicaid State Plan, provider manuals, and other policy documents.
Coordinate with the State’s fiscal agent on system changes.
Prepare and monitor public posting of information about policy and rate changes for public comment.
Collaborate with Agency of Human Services departments and share reimbursement expertise to update reimbursement rates and methodologies for existing or new programs.
Assist with resolving claims issues.
Calculate manual and enhanced pricing, provider taxes, Graduate Medical Education payments, and Disproportionate Share Hospital payments.
Assist with legislative bill review and analysis.

Benefits

80% state-paid medical premium and a dental plan at no cost for employees and their families.
12 paid holidays each year and a generous leave plan.
State-paid Family and Medical Leave Insurance (FMLI).
State defined-benefit pension plan and deferred compensation 457(b) plan.
Tuition reimbursement.
Flexible spending accounts for healthcare and childcare reimbursement.
Low-cost group life insurance.
Incentive-based wellness program.
Eligibility as a qualified employer for the Public Service Student Loan Forgiveness Program.
Hybrid work environment.