Senior Manager of Reimbursement and Fiscal Management

Department of Health and Human Services • Augusta, GA

2d • Hybrid

About The Position

The Senior Manager of Rate Setting supports the ongoing implementation and operations of a comprehensive, streamlined, and coherent system to set reimbursement rates for MaineCare services and programs. This role will be responsible for working with MaineCare’s Senior Management Team and the Delivery System Reform Unit to set the strategic direction of MaineCare reimbursement reform and leading the Rate Setting team to execute that vision.

Requirements

• To qualify, you must have a minimum of a combination of eight (8) years of education and/or experience.
• At least one (1) year of that experience must be in a supervisory/managerial capacity.
• At least two (2) years of that experience must be in cost, budget, financial analysis, or payment reform.

Nice To Haves

• A Master’s Degree in Business Administration, Non-Profit Administration, Finance, Public Policy, Health Care Administration or a closely related field.
• Experience with and knowledge of the Medicaid program and/or other health and human services programs serving low-income populations.
• Lived experience with Medicaid and/or other health-related social needs common to individuals and families receiving Medicaid coverage.
• Knowledge of the Governmental Accounting Standards Board’s Generally Accepted Accounting Principles (GASB/GAAP) or extensive knowledge related to financial analytics.
• Experience effectively leading a team of individuals with different roles, backgrounds, and perspectives to work toward achieving the organization’s goals, including contracted vendors.
• Experience with healthcare payment reform and the use of payment models and payment incentives to drive outcomes.
• Strong ability to communicate complex information through visual and verbal presentation and in writing to senior leadership and large external audiences, including the ability to translate complex information to a lay audience.
• An established record of managing complex fiscal issues with successful outcomes.

Responsibilities

• Provide leadership, oversight, and support for the rate setting team.
• Collaborate and manage relationships with a variety of partners, including provider groups, advocacy organizations, advisory groups, vendors, and other DHHS offices and State agencies.
• Develop and present analyses of and recommendations for rates and reimbursement methodologies, including alternative payment models, to a variety of internal DHHS and external partners.
• Analyze DHHS program fiscal performance and provide advice on opportunities for improvement and efficiencies to program/financial managers, along with recommendations for potential budget initiatives.
• Provide primary methodological and analytic oversight for several MaineCare value-based programs including, but not limited to, MaineCare’s Accountable Care Organization (ACO) program, Accountable Communities (AC), a multi-pronged initiative aimed at reducing costs while improving quality and outcomes for MaineCare members.
• Evaluate financial policies and procedures and implement appropriate modifications to improve efficiency and cost effectiveness, ensure compliance with applicable rules and regulations, and promote sound financial management practices.
• Oversee procurement, contracting, and contract management processes; secure and manage outside vendors working on rate setting projects, actuarial analysis and/or financial management analysis.
• Calculate payment amounts and generate invoices for supplemental payments to providers and determine appropriate allocations of state and federal matching funds.
• Oversee the generation and submission/publication of reporting required by the Centers for Medicare & Medicaid Services (CMS), including payment rate transparency reports required under CMS’s Access Rule.

Benefits

• Work-Life Fit – Rest is essential. Take time for yourself using 13 paid holidays, 12 days of sick leave , and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave.
• Health Insurance Coverage – The State of Maine pays 85%-100% of employee-only premiums ($12,845.82 - $15,112.76 annual value), depending on salary.
• Health Insurance Premium Credit – Participation decreases employee-only premiums by 5%.
• Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($395.72 annual value).
• Retirement Plan – The State contributes the equivalent of 18.91% of the employee's pay towards the Maine Public Employees Retirement System (MainePERS).
• Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child—including non-birthing and adoptive parents—receive six weeks of fully paid parental leave . Additional, unpaid leave may also be available, under the Family and Medical Leave Act .
• State employees are eligible for an extensive and highly competitive benefits package , covering many aspects of wellness.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees