Healthcare Reimbursement Manager
HybridMedicaidPricing & Rating
Role Summary
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Manager-level health actuarial role at the Virginia Department of Medical Assistance Services in Richmond, VA. You will lead the Capitation Rate Setting team to calculate, validate, and submit actuarially sound Medicaid and CHIP capitation rates and manage actuarial contractors. The role requires ASA credentialing and strong financial modelling, regulatory compliance, and stakeholder communication skills.
JOB DESCRIPTION SUMMARY
- Lead the Capitation Rate Setting team for Medicaid and CHIP capitation rates
- Own calculation, validation, and submission of actuarial capitation rates
- Manage actuarial contractors and deliver analyses to agency leadership
- Work on-site as required with telework as a privilege
- Requires ASA credential and strong Excel/SAS data skills
DOMAIN EXPERTISE
- Medicaid and CHIP capitation rate setting
- capitation reimbursement management and financial modeling
- applying state and federal regulations to actuarial analyses
- healthcare dataset analysis using Excel and database programming (SAS)
KEY REQUIREMENTS
- Must be an Associate of the Society of Actuaries (ASA)
- Considerable experience in capitation rate-setting for Medicaid/CHIP
- Considerable experience with financial modelling and regulatory compliance
- Strong Microsoft Excel skills for large healthcare datasets
- Eligible to work in the US without sponsorship (no employment-based sponsorship)
TECH STACK
- Excel
