Senior Medicaid Financial Analyst

HighCloud Solutions; Pierre (SD); Hybrid; USD 110,000 - 180,000; Full time

Job summary

HighCloud Solutions seeks a qualified contractor to provide technical support and analysis of South Dakota Medicaid's DSH supplemental payment program from Pierre, SD. The role is hybrid and long-term.

You will assess policy changes, collect data, calculate payments, and prepare schedules for the upcoming fiscal year, while educating hospitals and ensuring data quality and timely delivery.

Responsibilities

• Assess court decisions and federal policy impact on SD Medicaid DSH.
• Review State Plan resubmission processes for appropriateness.
• Recommend improvements to DSH payment administration and scope.
• Assist with DSH program audits.
• Gather data/documents from hospitals/DSS for DSH calculations.
• Calculate DSH rates and payments for the year under review.
• Draft DSH payment schedule for upcoming fiscal year.
• Educate hospitals on DSH requirements, data sources, and survey tools.
• Identify artifacts and documentation needed for DSH calculations.
• Propose hospital communications; require state approval before outreach.
• Gather data for the year under review; verify accuracy.
• Resolve data discrepancies with hospitals and DSS.
• Finalize payment model calculations and discuss with DSS.
• Provide education on best practices for documenting DSH eligibility.
• Ensure project quality and on-time delivery.

Job description

Location: Pierre, SD (Hybrid)

Duration: Long Term

Scope of Work

DSS is seeking a qualified vendor to provide technical support and analysis of South Dakota Medicaid's Disproportionate Share Hospital (DSH) supplemental payment program.

Activities include but are not limited to:

• Assess recent court decisions and changes/clarifications of federal policy and the potential impact to South Dakota Medicaid.
• Assess appropriateness of resubmissions for State Plan as necessary.
• Evaluate and recommend improvements to current administration of South Dakota Medicaid's DSH supplemental payments, including potential changes to the size and scope of the program.
• Assist with DSH program audits.
• Collection of the necessary information and documents from qualified and eligible providers required to calculate DSH payments.
• Calculation of DSH rates and payments.
• Draft a DSH Payment Schedule for the upcoming State Fiscal Year.
• Develop and provide education to participating hospitals on DSH requirements, data, sources, and survey tools.
• Identify the necessary artifacts, information, and documentation necessary to calculate DSH payments according to federal and State rules and regulations.
• Provide the State with proposed communication to eligible hospitals regarding the proposed methodology, data collection process, and deadlines for hospitals to submit data for the DSH payment calculation. The State must approve all communication prior to outreach to hospitals.
• Gather necessary data applicable to the year under review from eligible hospitals, DSS, and other sources.
• Review data for reasonableness and accuracy.
• Resolve any discrepancies in data with hospitals and DSS.
• Calculate the DSH payment model for the year under review and review and discuss the draft payment model with DSS.
• Perform any modification to the payment model calculation requested by DSS.
• Provide DSS with final payment model calculations in the manner specified by DSS.
• Develop and provide education to DSH eligible hospitals on DSH requirements, data sources, and survey tools, as well as best practices for hospitals related to documentation of DSH eligibility.
• Ensure overall project quality in adherence to proven standards and methodologies.
• Ensure the work activities are completed on time