Rate Development Director

Fahrenheit Advisors; Richmond (VA); On-site; USD 120,000 - 180,000; Full time

Job summary

Department of Medical Assistance Services (DMAS) in Virginia seeks a Rate Development Director to lead provider reimbursement rate setting and associated policy implementation. This executive role reports to the CFO and directs multiple units including Managed Care Rate Setting and Cost Settlement.

The position requires deep knowledge of Medicaid policy, rate policies, and regulatory processes, with responsibility for annual fiscal impact statements and inter-divisional collaboration.

Qualifications

• Considerable experience with Medicaid rate setting across managed care, fee-for-service, and cost settlements.
• Extensive ability to develop financial analysis processes and quantify fiscal impact of policy changes.
• Proven track record leading complex projects from inception to completion.
• Experience creating and implementing financial/healthcare programs and policies.
• Advanced Excel usage including PowerQuery/PowerPivot and pivot tables.

Responsibilities

• Lead design, implementation and oversight of reimbursement methodologies and fee schedules.
• Coordinate with actuaries to review capitation rate structures.
• Oversee supplemental payments, state-directed payments, and provider tax assessments.
• Manage cost reports settlement, auditing, and regulatory compliance for payments.
• Provide executive briefings and strategic planning for all provider reimbursement programs.

Skills

Medicaid rate setting

Policy analysis

Project management

Stakeholder communication

Leadership

Tools

Excel

PowerQuery/PowerPivot

Job description

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as the Rate Development Director in the Provider Rate Development Division.

Job responsibilities will include, but are not limited to:

• Provides leadership across the following units within the Provider Reimbursement division: Managed Care Rate Setting, Provider Rate Setting, Supplemental Payments and Cost Settlement and Audit.
• This position leads the design, implementation and oversight of reimbursement methodologies and fee schedules for healthcare providers and partners with internal and external actuaries to review capitation rate structures.
• The position manages the determination of payments through supplemental payment and state-directed payments and manages the provider tax assessments.
• The position also manages the settlement and auditing of institutional providers' cost reports and utilizing both regulatory and market information to determine appropriate and allowable payments.
• This position reports directly to the Deputy Director of Finance / Chief Finance Officer (CFO) and provides management and strategic planning for all provider reimbursement programs for the Department of Medical Assistance Services, in accordance with state and federal laws and established policies and procedures.
• This position requires a deep understanding of state and federal Medicaid policies, payments systems and healthcare reimbursement principles to ensure compliance with requirements on payment limits and rate adequacy.
• This position develops, interprets and implements policy related to Medicaid reimbursement methodologies.
• This position directs the analysis used to establish provider rates, serves as a liaison and chairs various work groups with provider associations and provides executive-level briefings.
• During the annual General Assembly session, ensures accurate and timely responses on fiscal impact statements and coordinates with the Budget Division Director.
• The business needs for this position have in office requirements to include but are not limited to attending in-person meetings and training, external meetings and occasional conferences and travel.

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

• Considerable experience with Medicaid rate setting for managed care programs; fee‑for‑service programs; supplemental payments; cost settlements; program planning; and health care programs, including Medicaid.
• Extensive experience developing processes and procedures for complex financial analysis; calculating fiscal impact of policy changes; analyzing complex data to draw conclusions; using data to make recommendations; and applying statistical and quantitative methods.
• Extensive experience leading complex projects, from inception to completion.
• Considerable experience in developing, creating, and implementing financial and health care programs and policies.
• Considerable experience as power user of Excel, including utilizing advanced formulas and aggregating data using PowerQuery, PowerPivot as well as pivot tables.
• Considerable knowledge of state and federal regulatory processes and applying regulations, law, and policy to financial model development.
• Considerable experience in meeting deadlines.
• Considerable experience communicating with internal and external stakeholders.
• Considerable experience in developing, creating, and implementing financial and health care programs and policies.
• Considerable experience in supervisory and human resource management.
• Considerable experience in program management and directing direct multiple, diverse operations.

Additional Considerations

There are no additional considerations 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).

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 the link: https://www.dars.virginia.gov/drs/cpid/PWContact.aspx or call DARS at 800‑552‑5019, or DBVI at 800‑622‑2155

From July 1, 2026, through January 21, 2029, applicants who were involuntarily separated from employment with the Federal Government on or after January 1, 2025, due to a reduction in force, budget reduction, or workforce restructuring initiative may be eligible for HB494 Federal Employee Priority Consideration. Applicants seeking HB494 Federal Employee Priority Consideration must identify themselves within the state application process and provide supporting documentation, including a Standard Form 50 (SF‑50), verifying their eligibility.

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.