DVHA Program Consultant

Overview

Join the Department of Vermont Health Access (DVHA) and make a meaningful impact as a DVHA Program Consultant. In this role, you will play a critical part in serving Vermonters by analyzing and managing reports and client cases within DVHA's Coordination of Benefits (COB) unit. Leverage your expertise to ensure efficient and effective healthcare benefit coordination while contributing to the well-being of the community.

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 DVHA Program Consultant has the following responsibilities:
·    Generates and pulls various reports with pharmacy and medical claims where further investigation of a primary payer not known to Medicaid is needed.
·    Analyzes and researches reports and cases referred to COB from other departments for assistance on investigation of a primary commercial or Medicare payer.
·    Works with primary insurers, CMS, pharmacies, various DVHA departments and outside contractors, Medicaid's Pharmacy Benefit Manager and claims processor to help resolve caseload referrals.
·    Helps resolve live access to care billing issues to assist clients and their ability to obtain health coverage needed.
·    Participate in projects or related duties that relate to Coordination of Benefits. 

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. We believe a hybrid work environment promotes autonomy and allows for increased flexibility and greater work/life balance.

Who May Apply

This position, DVHA Program Consultant (Job Requisition #52302), is open to all State employees and external applicants.
If you would like more information about this position, please contact victoria.marcotte@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

Work is generally performed within the normal office setting.

Some means of private transportation must be available for field visits. Work activities during the evening or weekend may occur, and some out-of-state travel may be required. Conflicting opinions relative to the correct application of rules, regulations and policies can be anticipated.

Minimum Qualifications

Two (2) years or more of experience in a healthcare or health insurance field with experience in either accounting, auditing, federal grants management, business administration or public or health administration. 

Total Compensation

As a State employee you are