Healthcare Reimbursement Manager

Title: Healthcare Reimbursement Manager

State Role

Title:

Financial Services Manager II

Hiring Range: $115,678 - $158,581

Pay Band: 6

Agency: Dept of Medical Assistance Svcs

Location: Dept of Medical Asst Services

Agency Website: (Use the "Apply for this Job" box below)..gov

Recruitment Type: General Public - G

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as the Healthcare Reimbursement Manager. The selected competitive candidate will provide exceptional delivery of services to the Provider Rate Development Division.

Job responsibilities will include, but are not limited to:

• The Healthcare Reimbursement Manager leads the Capitation Rate Setting team in the Provider Rate Development Division, overseeing all activities related to the calculation, validation, and submission of actuarially sound Medicaid and CHIP capitation rates for the Commonwealth of Virginia.
• This role ensures full compliance with federal and state requirements, effective management of actuarial contractors, and the delivery of timely, high-quality financial analysis to agency leadership and stakeholders.
• Leveraging advanced data analysis, actuarial expertise, and proactive stakeholder collaboration, the position supports the financial sustainability of contracted Managed Care Organizations (MCOs) and enhances the efficiency of provider reimbursement processes.
• The role directly addresses complex challenges with sound actuarial judgment to safeguard public resources, maintain public trust, and advance DMAS's mission to provide high-quality health care coverage for Virginians.
• Business needs include attending in-person meetings and internal/external stakeholder meetings.

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://.org

• Must be an Associate of the Society of Actuaries (ASA).
• Experience in finance, specifically in analyzing complex datasets to draw actionable conclusions and recommendations, and preparing detailed reports.
• Considerable knowledge of reimbursement and capitation rate-setting methodologies utilized by government agencies and private purchasers of healthcare services.
• Considerable experience in designing and implementing processes and procedures for advanced financial analysis, including statistical and quantitative methods.
• Considerable experience conducting in-depth research on public policy issues, with a focus on health policy and budget analysis, and interpreting findings to inform decision-making.
• Considerable experience managing capitation reimbursement activities, including rate-setting and financial modeling processes.
• Considerable experience using Microsoft Excel for healthcare financial analysis, project management, and aggregating large datasets for reporting purposes.
• Considerable experience interpreting and applying state and/or federal regulations to the development of financial models and actuarial analyses for governing managed care programs.
• Considerable experience meeting stringent deadlines while maintaining accuracy and attention to detail in deliverables.
• Considerable experience communicating effectively with internal and external stakeholders, including demonstrated ability to prepare and present written and oral reports on complex financial or policy issues.

• Experience in database programming (SAS or similar) to extract and analyze data.
• Member of the American Academy of Actuaries (MAAA).

Name: DMAS Talent Acquisition

Phone:

Email: askhcdtalentacqginia.gov

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.

We encourage individuals with disabilities to apply through the Commonwealth's Alternative Hiring Process. Applicants will need to provide their AHP Letter, and service‑connected veterans are encouraged to answer veteran status questions and submit disability documentation.

Note:

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

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.