Healthcare Rate Setting Analyst

Title: Healthcare Rate Setting Analyst

State Role Title: Financial Services Spec III

Hiring Range: $100,545 - $112,742

Pay Band: 6

Agency: Dept of Med Assistance Svcs

Location: Dept of Medical Asst Services

Agency Website: www.dmas.virginia.gov

Recruitment Type: General Public - G

Job Duties

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as the Healthcare Rate Setting Analyst in the Provider Rate Development Division.

Job responsibilities will include, but are not limited to:

The position works within the Fee-For-Service Rate Setting Unit within the Provider Rate Development Division and reports to the Healthcare Reimbursement Manager.

The position will serve as a subject matter expert for Medicaid rate development for one or more provider types such as long-term care, acute care, HCBS, etc.

May provide peer assistance in specialty areas.

Works both independently and as part of a team within existing guidelines and policies.

Serves as a resource to others in resolving more complex problems.

This position is responsible for developing complex and highly technical payment policy analyses for Medicaid and other programs administered by the Department of Medical
Assistance Services.

The incumbent serves as support staff in the development, review, and evaluation of methods and policies for rate setting and rate development.

The business needs for this position have in office requirements to include but are not limited to in-person meetings and trainings

Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org/

The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high quality health care coverage.

DMAS wants talented individuals who can align their experience with the mission of the agency and its core values – service, collaboration, trust, problem solving and adaptability.

At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.

Minimum Qualifications

Competitive candidates will meet these minimum qualifications:

Considerable work-related experience and knowledge in developing and completing complex financial analyses in an accurate and timely manner.

Considerable work-related knowledge and experience researching and solving complex issues and problems including knowledge of healthcare resource research and be able to apply these principles in practice.

Considerable work-related knowledge and experience in the application of statistics, quantitative methods, qualitative methods, and data science. Must be able to translate data into a graphic or visual representation.

Considerable work-related knowledge and experience in financial analysis, rate development, or actuarial science.

Considerable work-related knowledge and experience with calculating fiscal impacts of rate and policy changes.

Considerable experience using Excel, SAS, or SQL for developing complex analysis, aggregating data, drawing conclusions, and developing recommendations.

Considerable work-related knowledge of state and federal healthcare laws and regulatory processes.

Considerable experience meeting deadlines.

Considerable experience with communication with internal and external stakeholders including collaborating with other divisions and stakeholders to ensure proper implementation of business solutions.

Considerable experience maintaining system protocols in writing by updating processes, procedure documentation, and training materials.

Conducting regular audits and quality checks to ensure data integrity, troubleshoot data-related issues, and proposing solutions.

Additional Considerations

Competitive candidates should meet these additional considerations:

Knowledge of rate setting methodologies used by government and private purchasers of health care services such as DRG, EAPG, RUG, PDPM, and rate models.

Healthcare rate setting policy analysis, development, and interpretation experience.

Considerable exper