Reimbursement Strategy Analyst
Reimbursement Strategy Analyst
Posted on :
19-04-2025
Employer Active
1 Vacancy
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Yearly Salary
$ 64101 - 80116
Vacancy
1 Vacancy
Posted on :
19-04-2025
Job Description
PLEASE ATTACH THE ADDITIONAL REQUIREMENTS LISTED AT THE BOTTOM OF THIS PAGE
Job ID: 31085
Agency: Social Services
Location: Pierre Other locations may be considered for candidates currently working in the Division of Medical Services.
Salary: $$64101.60 to $80116.56 Annual Salary depending on qualifications
Pay Grade: K
Closing Date: 04/30/25
This is a FullTime 40 Hours Weekly position with the Social Services. For more information on the Social Services please visit .
The South Dakota Department of Social Services Division of Medical Services also knowns as South Dakota Medicaid plays a vital role in the healthcare of many South Dakotans. The program is one of the largest healthcare insurers in South Dakota covering 150000 individuals in state fiscal year 2025. The program primarily covers children of low income families including approximately 50 percent of children in South Dakota under age one. Other individuals covered by South Dakota Medicaid include lowincome pregnant women parents and other caretaker relatives seniors in nursing homes and individuals with physical or developmental disabilities.
The South Dakota Medicaid reimbursement strategy and analytics manager position plays an important role in helping set and implement reimbursement policies for Medicaid providers. Duties of the position include:
Licenses and Certifications:
A bachelors or masters degree in a relevant field is preferred.
The Ideal Candidate Will Have:
Knowledge Skills and Abilities:
Knowledge of:
Skill to:
Ability to:
Additional Requirements: To be considered please attach your resume.
This position is eligible for Veterans Preference per ARSD 55:10:02:08.
The State of South Dakota does not sponsor work visas for new or existing employees. All persons hired will be required to verify identity and eligibility to work in the United States and complete an Employment Eligibility Verification Form I9. The State of South Dakota as an employer will be using EVerify to complete employment eligibility verification upon hire.
The State of South Dakota offers $0 premium employee health insurance option plus eleven paid holidays generous vacation and sick leave accrual dental vision and other insurance options and retirement benefits. You can view our benefits information at . This position is a member of Class A retirement under SDRS.
Must apply online:
You must apply online emailed resumes or submissions will not be accepted.
South Dakota Bureau of Human Resources
Telephone: 605.773.3148 Email:
An Equal Opportunity Employer
#LIRemote #LIHybrid #LIOnsite
Job ID: 31085
Agency: Social Services
Location: Pierre Other locations may be considered for candidates currently working in the Division of Medical Services.
Salary: $$64101.60 to $80116.56 Annual Salary depending on qualifications
Pay Grade: K
Closing Date: 04/30/25
This is a FullTime 40 Hours Weekly position with the Social Services. For more information on the Social Services please visit .
The South Dakota Department of Social Services Division of Medical Services also knowns as South Dakota Medicaid plays a vital role in the healthcare of many South Dakotans. The program is one of the largest healthcare insurers in South Dakota covering 150000 individuals in state fiscal year 2025. The program primarily covers children of low income families including approximately 50 percent of children in South Dakota under age one. Other individuals covered by South Dakota Medicaid include lowincome pregnant women parents and other caretaker relatives seniors in nursing homes and individuals with physical or developmental disabilities.
The South Dakota Medicaid reimbursement strategy and analytics manager position plays an important role in helping set and implement reimbursement policies for Medicaid providers. Duties of the position include:
- Managing and coordinating updates of reimbursement methodologies including annual rate updates for professional and facility services;
- Researching reimbursement best practices;
- Researching other payers reimbursement policies and rates;
- Providing technical expertise to program staff other agencies and clients receiving program services to ensure programs operate within set standards and services are delivered efficiently and effectively;
- Developing revising implementing administering and interpreting changes to policies procedures and operational manuals to ensure the program operates in compliance with department goals and objectives and all pertinent laws rules and regulations
- Drafting reimbursement and coverage policies;
- Analyzing Medicaid claims data to inform reimbursement policy decisions;
- Preparing Medicaid financial reports from claims data;
- Calculating fiscal impacts for Medicaid initiatives using claims data and modeling analysis;
- Managing Medicaid vendor contracts related to reimbursement; and
- Overseeing the annual Upper Payment Limit demonstration process.
Licenses and Certifications:
A bachelors or masters degree in a relevant field is preferred.
The Ideal Candidate Will Have:
- data analytics experience and knowledge including knowledge of SQL;
- project management and leadership skills;
- experience in healthcare administration or with healthcare reimbursement methodologies including DRG and APC;
- effective verbal and written communication.
Knowledge Skills and Abilities:
Knowledge of:
- principles and theories of social services program planning organization direction interpretation and management information technology support requirements;
- federal and state legislation policies and regulations governing the assigned social services program area(s);
- Medicaid reimbursement methodologies;
- Upper Payment Limits (UPLs);
- Microsoft Suite.
Skill to:
- logically reason and think critically;
- lead a team implementing a change;
- research and analyze data;
- manage multiple projects.
Ability to:
- pay high attention to detail;
- analyze and interpret data;
- plan direct and develop initiatives and recommendations for program and budgetary modifications and/or pertaining to the departmental support/nonsupport for new federal and/or state initiatives and/or program revisions and proposals;
- prepare clear and concise documents reports and correspondence which reflect relevant facts;
- identify recommend and implement process improvements and efficiencies;
- conduct strategic planning and problem solving;
- prepare review and analyze reports;
- work well in a collaborative environment.
Additional Requirements: To be considered please attach your resume.
This position is eligible for Veterans Preference per ARSD 55:10:02:08.
The State of South Dakota does not sponsor work visas for new or existing employees. All persons hired will be required to verify identity and eligibility to work in the United States and complete an Employment Eligibility Verification Form I9. The State of South Dakota as an employer will be using EVerify to complete employment eligibility verification upon hire.
The State of South Dakota offers $0 premium employee health insurance option plus eleven paid holidays generous vacation and sick leave accrual dental vision and other insurance options and retirement benefits. You can view our benefits information at . This position is a member of Class A retirement under SDRS.
Must apply online:
You must apply online emailed resumes or submissions will not be accepted.
South Dakota Bureau of Human Resources
Telephone: 605.773.3148 Email:
An Equal Opportunity Employer
#LIRemote #LIHybrid #LIOnsite
Required Experience:
IC
Employment Type
Full Time
Key Skills
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