Medicaid Operations Administrator Job at State of Vermont
State of Vermont Waterbury, VT
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. Eleven paid state holidays, in addition to a robust benefits package.
The Medicaid Operations Administrator has the following responsibilities:
- 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.
- Direct annual fee schedule updates for Federally Qualified Health Centers and Rural Health Centers, Physician Administered Drugs, and another small program. Rate updates include the gathering of data, fiscal review and analysis, rate modeling and the calculation of fiscal impacts.
- Review and completion of timely filing requests.
- Liaison for quarterly code updates.
- 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 and provider manuals.
- 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 Negotiating and preparing special rate agreements.
o Calculating manual and enhanced pricing.
o Assisting with legislative bill review and analysis.
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.
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. We believe a hybrid work environment promotes autonomy and allows for increased flexibility and greater work/life balance.
Who May Apply
This position, Medicaid Operations Administrator (Job Requisition #47238), is open to all State employees and external applicants.
If you would like more information about this position, please contact patricia.elias@vermont.gov.
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
Bachelor's degree AND four (4) years or more at or above a technical or professional level in health, welfare, mental health, or social services INCLUDING one (1) year or more of supervisory experience in any field.
OR
Master's degree work in a human services or administration field AND two (2) years or more at or above a technical or professional level in health, welfare, mental health, or social services INCLUDING one (1) year or more of supervisory experience in any field.
OR
Two years of full-time college coursework OR associate's degree AND six (6) years or more at or above a technical or professional level in health, welfare, mental health, or social services INCLUDING one (1) year or more of supervisory experience in any field.
OR
High School diploma or equivalent AND eight (8) years or more at or above a technical or professional level in health, welfare, mental health, or social services INCLUDING one (1) year or more of supervisory experience in any field.
Preferred Qualifications
College degree in the areas of human services, business administration or public administration.
The ideal candidate will possess strong financial analysis, communication skills, and the ability to collaborate and gain cooperation and support of a diverse group of individuals and organizations. Familiarity with health care claims processing is highly desirable but not required.
Total Compensation
- 80% State paid medical premium
- Dental Plan at no cost for employees and their families
- Flexible Spending healthcare and childcare reimbursement accounts
- Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan
- Work/Life balance: 11 paid holidays each year and a generous leave plan; many jobs also allow for a flexible schedule
- Low cost group life insurance
- Tuition Reimbursement
- Incentive-based Wellness Program
- Qualified Employer for Public Service Student Loan Forgiveness Program
Equal Opportunity Employer
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