Rate Development Director

About the Role

The Department of Medical Assistance Services (DMAS) is offering a competitive opportunity to serve as the Rate Development Director in the Provider Rate Development Division. This position reports directly to the Deputy Director of Finance / Chief Finance Officer (CFO) and provides management and strategic planning for all provider reimbursement programs for the Department of Medical Assistance Services, in accordance with state and federal laws and established policies and procedures.

Responsibilities

• Provides leadership across the following units within the Provider Reimbursement division: Managed Care Rate Setting, Provider Rate Setting, Supplemental Payments and Cost Settlement and Audit.
• Leads the design, implementation and oversight of reimbursement methodologies and fee schedules for healthcare providers and partners with internal and external actuaries to review capitation rate structures.
• Manages the determination of payments through supplemental payment and state-directed payments and manages the provider tax assessments.
• Manages the settlement and auditing of institutional providers' cost reports and utilizes both regulatory and market information to determine appropriate and allowable payments.
• Develops, interprets and implements policy related to Medicaid reimbursement methodologies.
• Directs the analysis used to establish provider rates, serves as a liaison and chairs various work groups with provider associations and provides executive-level briefings.
• During the annual General Assembly session, ensures accurate and timely responses on fiscal impact statements and coordinates with the Budget Division Director.

Requirements

• Considerable experience with Medicaid rate setting for managed care programs; fee-for-service programs; supplemental payments; cost settlements; program planning; and health care programs, including Medicaid.
• Extensive experience developing processes and procedures for complex financial analysis; calculating fiscal impact of policy changes; analyzing complex data to draw conclusions; using data to make recommendations; and applying statistical and quantitative methods.
• Extensive experience leading complex projects, from inception to completion.
• Considerable experience in developing, creating, and implementing financial and health care programs and policies.
• Considerable experience as power user of Excel, including utilizing advanced formulas and aggregating data using PowerQuery, PowerPivot as well as pivot tables.
• Considerable knowledge of state and federal regulatory processes and applying regulations, law, and policy to financial model development.
• Considerable experience in meeting deadlines.
• Considerable experience communicating with internal and external stakeholders.
• Considerable experience in supervisory and human resource management.
• Considerable experience in program management and directing multiple, diverse operations.
• This position requires a deep understanding of state and federal Medicaid policies, payments systems and healthcare reimbursement principles to ensure compliance with requirements on payment limits and rate adequacy.

Schedule and Work Location

The business needs for this position have in office requirements to include but are not limited to attending in-person meetings and training, external meetings and occasional conferences and travel. Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC.