Medicaid Operations Administrator

State of Vermont • Waterbury, VT

10h • 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 position is part of DVHA’s Reimbursement Unit and supports reimbursement work affecting Vermonters. It includes a Monday–Friday schedule and a supportive hybrid work environment.

The role oversees updates to a range of Medicaid fee schedules and reimbursement methodologies, conducts rate and fiscal analyses, calculates supplemental payments, and interprets federal and state policies. It also involves updating Medicaid policy documents, coordinating system changes with the State’s fiscal agent, preparing information for public comment, and collaborating with other Agency of Human Services departments on reimbursement work. Other assignments may include claims issue resolution, payment and provider-tax calculations, legislative review, and related reimbursement analyses.

The position is performed largely in a standard office setting, with predictable field travel requiring access to private transportation. Duties may occasionally be required outside the normal workday and workweek. The role involves frequent interaction with state and federal officials and meetings with providers, the fiscal agent, and members of the public; some discussions may be stressful.

Requirements

• Master’s degree work in a human services or administration field and at least one year of experience in health, welfare, mental health, or social services; OR a bachelor’s degree and at least two years of such experience; OR two years of full-time college coursework or an associate’s degree and at least four years of such experience; OR at least six years of such experience.
• Proficiency in Microsoft Office, particularly Excel.
• Strong communication skills and ability to collaborate effectively with diverse individuals and organizations.
• Pass any background investigation applicable to the position; checks may include Vermont and/or national criminal records, DMV records, and adult and child abuse registries, as appropriate.

Nice To Haves

• A college degree in human services, business administration, or public administration.
• Strong financial analysis, data gathering, manipulation, and review skills, including the ability to evaluate and compare financial and medical claims data.
• Experience with healthcare claims processing and/or healthcare financial analysis.
• Familiarity with medical coding.

Responsibilities

• Direct annual updates to Medicaid fee schedules and reimbursement methodologies, including IPPS, OPPS, professional, clinical laboratory, DMEPOS, and dental fee schedules, as well as FQHC and RHC reimbursement methodologies.
• Gather data, conduct fiscal reviews and analyses, model rates, and calculate fiscal impacts for rate and fee schedule updates.
• Gather data and calculate annual supplemental payments to hospitals 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.
• Work with the State’s fiscal agent on system changes.
• Prepare and monitor the posting of information about policy and rate changes for public comment.
• Collaborate with other Agency of Human Services departments and share reimbursement expertise to update 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, as assigned.
• 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 healthcare and childcare reimbursement accounts.
• Low-cost group life insurance.
• Incentive-based wellness program.
• Qualified Employer for Public Service Student Loan Forgiveness Program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level