Job Specification Details

Planning, reimbursement, policy development and analysis work at a professional level for the Department of Health Access (DVHA) involving assessment of health care alternatives and their impact on the Medicaid program. Duties include coordination with all State departments administering programs funded by Medicaid. Work is performed under the general direction of one of the DVHA Deputy Directors.

Oversees reimbursement policy for DVHA and advises on all programmatic reimbursement decisions. Interacts closely with providers, departments and provider associations on Vermont Medicaid reimbursement issues. Reviews and comments on actions and proposals from federal, state and other entities. Maintains current and accurate information in the three policy documents: the reimbursement section of the Medicaid State Plan, the Provider Manual and its Supplements and Pricing Policy Manual. Works with Deputy Director and DVHA to implement the comprehensive review of each Edit/Audit that is defined in the MMIS system. Coordinates Code Equity Project to develop and implement a comprehensive review of current fees. Prepares documentation substantiating plan revisions and assist other departments with payment policy issues. Arranges for public notice of proposed State Plan chart. Work is performed under the general direction of one of the DVHA Deputy Directors. Performs related duties as required.

Duties are performed primarily in a standard office setting, but with some travel, for which private means of transportation must be available. Strongly divergent opinions may be encountered in meetings with interest groups and the general public. Significant pressure from deadlines may be anticipated.

Considerable knowledge of the principles and practices of program planning and evaluation.

Considerable knowledge of the development, implementation and interpretation of eligibility standards for benefit programs.
Considerable knowledge of research methods and techniques.
Working knowledge of governmental health care administration.
Working knowledge of current issues and trends in the health care and long term care fields.

Proficiency in all aspects of reimbursement
Ability to direct and implement complex research, planning and policy development projects.
Ability to interpret complex regulations and to analyze their impact on current and proposed programs.
Ability to coordinate and integrate programs administered by a variety of agencies.
Ability to use computerized word processing, spread sheet, and forecasting software.
Ability to communicate effectively, both orally and in writing.
Ability to establish and maintain effective working relationships.

Education: Bachelor's degree.

Experience: Four years at a professional level in program and policy development, evaluation, analysis and reimbursement.

Note: Graduate coursework in a business administration, health care or a human services field may be substituted for up to two years of the general experience on a semester for six months basis.

Candidates must pass any level of background investigation applicable to the position. In accordance with AHS Policy 4.02, Hiring Standards, Vermont and/or national criminal record checks, as well as DMV and adult and child abuse registry checks, as appropriate to the position under recruitment, will be conducted on candidates, with the exception of those who are current classified state employees seeking transfer, promotion or demotion into an AHS classified position or are persons exercising re-employment (RIF) rights.