Overview

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.

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.

Who May Apply

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 [email protected]
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.

Environmental Factors

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.

Minimum Qualifications

Bachelor's 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

Master's 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.

Total Compensation

As a State employee you are offered a great career opportunity, but it's more than a paycheck. The State's 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.