Medicaid Operations Administrator

Overview

Direct and coordinate annual rate updates and/or major policy changes to existing or new payment methodologies for programs administered under the Department of Vermont Health Access (DVHA). DVHA's Reimbursement Unit is seeking a Medicaid Operations Administrator who will have a diverse workload that affects the lives of everyday Vermonters. Have the work/life balance you need with a Monday-Friday schedule and a supportive hybrid work environment. Twelve paid state holidays, in addition to a robust benefits package.

The Medicaid Operations Administrator has the following responsibilities:

• Direct annual fee schedule updates for 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.

• Conduct rate/fee schedule update activities, including the gathering of data, fiscal review and analysis, rate modeling and the calculation of fiscal impacts.

• Gather data and calculate annual supplemental payments to hospitals for the Disproportionate Share Hospital program. Duties will include interactions with staff from Vermont hospitals, other departments, and fiscal agent.

• Review and completion of timely filing requests.

• Interpret existing federal and state policies and procedures.

• Evaluate and analyze programmatic impact of proposed regulatory and policy changes.

• Review and prepare updates to the Medicaid State Plan, provider manuals, and other policy documents.

• Work with the State's fiscal agent on system changes.

• Prepare and monitor the posting of information about policy and rate changes for public comment.

• Collaborate and share reimbursement expertise with other Agency of Human Services departments in efforts to update their reimbursement rates and methodologies for existing or new programs.

• Other areas of work may include the following: o Assistance with the resolution of claims issues. o Calculating manual and enhanced pricing. o Calculating provider taxes o Calculating Graduate Medical Education (GME) payments. o Calculating Disproportionate Share Hospital (DSH) payments. o Assisting with legislative bill review and analysis

DVHA

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.

Who May Apply

This position, Medicaid Operations Administrator (Job Requisition #56105), 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.

AHS BACKGROUND CHECKS: Candidates must pass any level of background investigation applicable to the position. In 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.

Environmental Factors

Duties are performed largely in standard office setting but with predictable need for field travel for which private means of transportation must be available. The role may require performance of duties outside of the normal workday and workweek. Interaction with state and federal officials is frequent. Meetings with providers, fiscal agent, and interested publics may illicit strong feelings and create stressful situations.

Minimum Qualifications

Master's degree work in a human services or administration field AND one (1) year or more experience in health, welfare, mental health, or social services.

OR

Bachelor's degree AND two (2) years or more experience in health, welfare, mental health, or social services.

OR

Two years of full-time college coursework OR associate's degree AND four (4) years or more experience in health, welfare, mental health, or social services.

OR

Six (6) years or more experience in health, welfare, mental health, or social services.

Preferred Qualifications

College degree in the areas of human services, business administration or public administration.

The ideal candidate will possess strong financial analysis, data gathering, manipulation and review skills, including the ability to evaluate and compare financial and medical claims data. Proficiency in Microsoft Office, particularly Excel, is required, along with strong communication skills and the ability to collaborate effectively with a diverse range of individuals and organizations. Experience with healthcare claims processing and/or healthcare financial analysis is strongly preferred, with familiarity in medical coding considered an additional asset.

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.

Equal Opportunity Employer

The State of Vermont celebrates diversity, and is committed to providing an environment of mutual respect and meaningful inclusion that represents a variety of backgrounds, perspectives, and skills. The State does not discriminate in employment on the basis of race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, membership in an employee organization, family medical history or genetic information, or family or parental status. The State’s employment decisions are merit-based. Retaliatory adverse employment actions by the State are forbidden.