Medicaid Rate Methodology Specialist

Mercer • Atlanta, GA

1d • $115,200 - $230,400 • Hybrid

About The Position

We are seeking a talented individual to join our Provider Rates Team in our Government Healthcare Services Consulting (GHSC) practice at Mercer.
The Medicaid Rate Methodology Specialist will partner with state governments to design and develop facility methodologies and rates, working closely with clients, team members and external stakeholders. This role provides you with an opportunity to work in a team environment to ensure client recommendations contain multiple points of view. Beyond the in-depth training provided, new employees are included on client teams immediately, providing unique opportunities to learn more while helping team members with critical workloads and making a difference to our clients. As part of Mercer, the Government Human Services Consulting (GHSC) team offers its expertise within a small business atmosphere.

Requirements

• Bachelor’s degree (required)
• 5+ years of experience as leader of Medicaid facility or hospital provider reimbursement for a state or federal government agency, nationally recognized organization, or consulting firm, etc. (can be congruent with the following);
• 7+ years of Medicaid experience – either through program administration, consulting support and/or research.
• Experience with industry-standard and emerging best practices in innovations and interventions regarding provider reimbursement
• Experience with rate development components such as methodology design, provider cost variations and consideration for regulations.
• Experience engaging stakeholders of federal, state, or local government agencies, and provider communities.
• Experience with Medicaid claims data preferred, with particular concentration on Medicaid claims and encounters, including Managed Care delivery models.
• Experience with federal and Medicare reporting associated with hospitals preferred (Facility Cost Reports, MDS data, CMS-published facility reports and data, Medicare Hospital Cost Reports, etc.)

Nice To Haves

• Some level of hospital or nursing facility reimbursement leadership experience.
• Familiarity with Medicaid Managed Care quality incentive programs and/or VBP.

Responsibilities

• Be a client-facing consultant with expertise in Medicaid facility reimbursement design and rate setting and implementation, with a focus on inpatient/outpatient hospital and nursing facility reimbursement.
• Provide strategic support to State clients when establishing facility reimbursement rates, keeping a pulse on Medicaid provider reimbursement for other states and payers, including Medicare.
• Guide clients in all areas of a reimbursement methodology design, such as: rate setting design and development, Medicaid/Medicare cost report collection and analysis, stakeholder partnering, State implementation and operations and establishment of strategic plans/goals, data validation and analysis, and regulation implementation.
• Present recommendations to clients to ensure successful implementation of facility reimbursement rates.
• Establish tools to identify important data elements that should be captured and evaluated. Including guidance on common issues and best practices regarding facility cost reports.
• Establish and mentor team of staff to support Medicaid provider reimbursement projects. Recommend appropriate training to prepare teams for existing and future work.

Benefits

• We help you be your best through professional development opportunities, interesting work and supportive leaders.
• We foster a vibrant and inclusive culture where you can work with talented colleagues to create new solutions and have impact for colleagues, clients and communities.
• Our scale enables us to provide a range of career opportunities, as well as benefits and rewards to enhance your well-being.
• health and welfare benefits
• tuition assistance
• 401K savings and other retirement programs
• employee assistance programs

What This Job Offers

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