Healthcare Reimbursement Manager

Healthcare Reimbursement Manager

The Department of Medical Assistance Services (DMAS) seeks a Healthcare Reimbursement Manager to lead the Capitation Rate Setting team within the Provider Rate Development Division. The role involves calculating, validating, and submitting actuarially sound Medicaid and CHIP capitation rates for the Commonwealth of Virginia while ensuring full compliance with federal and state requirements. The manager will oversee actuarial contractors, deliver timely financial analysis to agency leadership, and collaborate with stakeholders to support the financial sustainability of managed care organizations.

• Lead the Capitation Rate Setting team and oversee all activities related to capitation rate calculation, validation, and submission.
• Ensure compliance with federal and state regulations and maintain actuarially sound rate settings.
• Manage relationships with actuarial contractors and internal stakeholders.
• Provide high‑quality financial analysis and reporting to agency leadership.
• Collaborate with stakeholders to enhance efficiency of provider reimbursement processes.
• Attend in‑person and stakeholder meetings as required.

• Associate of the Society of Actuaries (ASA) certification.
• Extensive experience in finance, including analysis of complex datasets and preparation of detailed reports.
• Deep knowledge of reimbursement and capitation rate‑setting methodologies used by government agencies.
• Experience designing and implementing processes and procedures for advanced financial analysis.
• Research experience on public policy issues with a focus on health policy and budget analysis.
• Experience managing capitation reimbursement activities, including rate‑setting and financial modeling.
• Proficiency with Microsoft Excel for healthcare financial analysis and large dataset reporting.
• Ability to interpret and apply state and federal regulations to financial models and actuarial analyses.
• Strong communication skills, including preparation and presentation of written and oral reports on complex financial or policy issues.

• Experience in database programming (e.g., SAS) for data extraction and analysis.
• Member of the American Academy of Actuaries (MAAA).

The Department of Medical Assistance Services practices fair and equal employment opportunity to all employees and applicants in accordance with applicable laws and regulations. Discrimination on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, veteran status, or disability is prohibited.

Applications close on 23 Dec 2025. The position is advertised as of 20 Nov 2025.