DVHA Rate Setting Manager

Join our team to lead a group of reimbursement professionals and oversee a portfolio of Medicaid reimbursement methodologies at the Department of Vermont Health Access. Enjoy work/life balance with a Monday-Friday schedule and a supportive hybrid work environment.

About the Role

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.

Responsibilities

• Manages a variety of Medicaid fee schedules and other methodologies, including but not limited to:
  • Inpatient Prospective Payment System (IPPS)
  • Outpatient Prospective Payment System (OPPS)
  • Medicaid Professional fee schedule
  • Clinical Laboratory fee schedule
  • Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule
  • Dental fee schedule
  • 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

Requirements

• 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

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

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
• 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.

About Vermont

Vermont is a "small but mighty" state, ranked as one of the top 10 states to raise a family in 2022. We are nationwide leaders for progressive social and educational policies. Located in Northern New England, we are 1.5 hours from Montreal and 3.5 hours from Boston. Vermont offers 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.

Environmental Factors

• Duties are performed primarily in a standard office setting
• Occasional travel to regulated facilities, for which private means of transportation must be available
• Some work outside of normal office hours may be required

Benefits

• 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.