DVHA Rate Setting Manager

Join our team to lead a group of reimbursement professionals and oversee a portfolio of Medicaid reimbursement methodologies! The Department of Vermont Health Access is seeking an experienced professional to lead its Reimbursement unit. Have the work/life balance you need with a Monday-Friday schedule and a supportive hybrid work environment.
The Reimbursement unit plays a critical role in establishing implementing and maintaining fee-for-service payment methodologies across the Medicaid program and in partnership with departments within the Agency of Human Services.

The Rate Setting Manager has the following responsibilities:
Manages a variety of Medicaid fee schedules and other methodologies including but not limited to:
o Inpatient Prospective Payment System (IPPS).
o Outpatient Prospective Payment System (OPPS).
o Medicaid Professional fee schedule.
o Clinical Laboratory fee schedule.
o Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) fee schedule.
o Dental fee schedule.
o Various methodologies supporting Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) reimbursement.
General oversight of activities related to provider tax calculations and Graduate Medical Education (GME) payment calculations.
Maintaining current and accurate information within policy documents such as the Medicaid State Plan and provider manuals.
Analysis of annual updates to relevant federal and state regulations
Coordination with appropriate internal and external partners to implement annual updates in a timely manner.

The ideal Rate Setting Manager will have the following skills and experience:
Practical experience with health insurer payment methodologies and organizational operations.
Strong analytic skills.
Leadership experience.
Excellent written and verbal communication skills to represent methodologies and annual updates in leadership forums and with other key stakeholders as needed.
Strong competencies in federal regulations and medical coding.
Ability to operate independently in addition to working collaboratively with various partners at a professional level.

Mission:
The Department of Vermont Health Access (DVHA)s mission is to improve Vermonters health and well-being by providing access to high-quality cost-effective health care. We have identified three priorities that support our mission: Advancing value-based payments modernizing information technology infrastructure and operational performance improvement. Our department commits to executing our responsibilities and priorities while adhering to three core values: Transparency Integrity and Service.

Diversity Equity and Inclusion:
As part of our values of transparency integrity and service we are committed to supporting diversity equity inclusion and accessibility as part of our person-centered culture. We actively celebrate our colleagues and future colleagues different abilities racial identity sexual orientation ethnicity age and gender. Everyone is welcome and supported here.

Our State:
Vermont is a small but mighty state. We are ranked as one of the top 10 states to raise a family in 2022. We are nationwide leaders for progressive social and educational policies. We are in Northern New England 1.5 hours from Montreal and 3.5 hours from Boston. We have beautiful Lake Champlain the Green Mountains and year-round outdoor activities.

Telework:
The Department of Vermont Health Access (DVHA) supports a hybrid work environment. Upon hire employees work with their supervisor to create a schedule that aligns with the business needs of the unit.

This position DVHA Rate Setting Manager (Job Requisition #55589) is open to all State employees and external applicants.
If you would like more information about this position please contact
Resumes will not be accepted via e-mail. You must apply online to be considered.
Please note that multiple positions in the same work location may be filled from this job posting.

AHS BACKGROUND CHECKS: Candidates must pass any level of background investigation applicable to the accordance with AHS Policy 4.02 Hiring Standards Vermont and/or national criminal record checks as well as DMV and adult and child abuse registry checks as appropriate to the position under recruitment will be conducted on candidates with the exception of those who are current classified state employees seeking transfer promotion or demotion into an AHS classified position or are persons exercising re-employment (RIF) rights.

Duties are performed primarily in a standard office setting but with the need for occasional travel to regulated facilities for which private means of transportation must be available. Some work outside of normal office hours may be required.

Bachelors degree in accounting public or business administration or a related field AND four (4) years or more of experience at a professional level in health policy health services research economics accounting auditing or public or business administration INCLUDING two (2) years in a health care-related role and two (2) years in a supervisory or policy development role.

OR

Current or past licensure as a CPA AND four (4) years or more of experience at a professional level in health policy health services research economics accounting auditing or public or business administration INCLUDING two (2) years in a health care-related role and two (2) years in a supervisory or policy development role.

OR

Masters degree in accounting public administration law or a field related to health care AND two (2) years or more at a professional level in health policy health services research economics accounting auditing or public or business administration.

As a State employee you are offered a great career opportunity but its more than a paycheck. The States total compensation package features an outstanding set of employee benefits that are worth about 30% of your total compensation including:

• 80% State paid medical premium and a dental plan at no cost for employees and their families
• Work/Life balance: 12 paid holidays each year and a generous leave plan
• State Paid Family and Medical Leave Insurance (FMLI)
• Two ways to save for your retirement: A State defined benefit pension plan and a 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

Want the specifics Explore the Benefits of State Employment on our website.