Healthcare Reimbursement Analyst

Title: Healthcare Reimbursement Analyst

State Role Title: Financial Services Spec III

Hiring Range: $100,000 - $ 106,000

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 Reimbursement Analyst in the Provider Reimbursement 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 Setting Division and reports to the Healthcare Reimbursement Manager.

The position will serve as subject matter expert for Medicaid reimbursement for one or more provider types such as long term care, acute care, or HCBS.

May provide peer assistance in specialty areas.

Works both independently and as part of a team member 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 analysis for Medicaid and other programs administered by the Department of Medical Assistance Services.

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

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 principals 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, reimbursement 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 oral and written 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 process, procedure documentation, and training materials.

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

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 reimbursement policy analysis, development, and interpretation experience.

Considerable experience with critical thinking and problem-solving skills, maturity of judgement and comfort with on-demand decision making to resolve problems, and to seek support when needed.

Special Instructions

You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position.

The Virginia Department of Medical Assistance Services (DMAS) does not offer employment-based Sponsorship. Selected candidates will have their work authorization completed using the E‐Verify Program.

The Department of Medical Assistance Services (DMAS) is an Executive Branch agency that will adhere to all policies and procedures, to include the Commonwealth’s Department of Human Resource Management Policy 1.61 Teleworking.

This position requires a fingerprint based Criminal History Background Check, Education Checks if applicable, Work History Verification with references.

This position requires the submission of a Statement of Economic Interest (financial disclosure).

If you wish to apply for a job with the Department of Medical Assistance Services, an application and/or resume for employment must be submitted electronically through this website. Mailed, faxed, emailed, or hand-delivered applications/resumes will not be accepted. Consideration for an interview is based solely on the relevant information presented in the state application and/or resume submitted before the closing date.

Applications and/or resumes should include relevant work history which indicates your qualifications for this position.

The Department of Medical Assistance Services practices fair and equal employment opportunity to all employees and applicants in accordance with applicable laws and regulations. It is our policy to prohibit discrimination on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce.

In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth's Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly called a Certificate of Disability) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans may also apply via the AHP if they also provide an AHP Letter. To request an AHP Letter, use this link: https://www.dars.virginia.gov/drs/cpid/PWContact.aspx or call DARS at 800-552-5019, or DBVI at 800-622-2155

The Department of Medical Assistance Services is a V3 certified state agency that provides hiring preference to veterans and members of the reserves and/or National Guard in support of executive order 29, (2010). If you are a Veteran or Spouse of a Veteran or Active Military Member, DMAS encourages you to apply and respond accordingly on your state application.

Contact Information

Name: DMAS Talent Acquisition

Phone: 804-225-4407

Email: askhcdtalentacq@dmas.virginia.gov

In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.

Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.