Title: Healthcare Reimbursement Manager

State Role Title:Financial Services Manager II

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

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 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. By 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. The business needs for this position have in office requirements to include but are not limited to attending in-person meetings and attending internal and external stakeholder's 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://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:

Required Certifications: Must be an Associate of the Society of Actuaries (ASA).

Experience in finance, specifically in analyzing complex datasets to draw actionable conclusions and recommendations, as well as 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 interpret 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.

Additional Considerations

Competitive candidates should meet these additional considerations:

Experience in database programming (SAS or similar) to extract and analyze data.

Member of the American Academy of Actuaries (MAAA).

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 could be expected to work in the office as driven by business needs.

Telework arrangements are a privilege and may be rescinded at any time based on performance and/or business need. The agency reserves the right to modify or terminate a telework arrangement, provided that reasonable notice is given to the employee.

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.

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Healthcare Reimbursement Manager