DVHA Rate Setting Manager

at State of Vermont in Waterbury, Vermont, United States

Job Description

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.

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.