Note: The job is a remote job and is open to candidates in USA. The State of South Dakota, Department of Social Services, Division of Medical Services, is seeking a consultant to support the state’s Medicaid DSH supplemental payment program. The role focuses on hospital data analysis, payment calculations, program audits, regulatory compliance, and recommendations to improve program administration.

Responsibilities

• Analyze recent court decisions and changes or clarifications in federal policies affecting South Dakota Medicaid and its DSH supplemental payment program
• Evaluate the appropriateness of State Plan resubmissions and recommend updates when necessary
• Review and recommend improvements to the administration, size, scope, and methodology of the DSH supplemental payment program
• Assist with DSH program audits and ensure compliance with applicable federal and state requirements
• Collect required information, supporting documents, and data from eligible hospitals, DSS, and other relevant sources
• Calculate DSH payment rates and supplemental payment amounts in accordance with applicable regulations
• Develop the annual DSH Payment Schedule for the upcoming state fiscal year
• Identify and validate the documentation, data sources, and supporting artifacts required for accurate DSH payment calculations
• Develop proposed communications to eligible hospitals regarding payment methodologies, data collection requirements, and submission deadlines
• Review hospital-submitted data for accuracy, completeness, and reasonableness
• Investigate and resolve data discrepancies in coordination with hospitals and DSS
• Develop and maintain the DSH payment calculation model for the applicable review year
• Present draft payment models to DSS, incorporate requested modifications, and deliver final payment calculations in the required format
• Educate DSH-eligible hospitals on program requirements, data sources, survey tools, and best practices for documenting DSH eligibility
• Ensure project deliverables meet established quality standards, regulatory requirements, and deadlines
• Maintain clear documentation and communicate project findings, recommendations, and potential compliance issues to DSS stakeholders

Skills

• Minimum 3 years of experience working with Medicaid rules, regulations, policies, and related issues
• Minimum 3 years of experience working with Disproportionate Share Hospital (DSH) rules, regulations, payment methodologies, and related program requirements
• Demonstrated experience working with Medicaid data, including data collection, validation, analysis, and reporting
• Strong understanding of Medicaid DSH supplemental payment programs and applicable federal and state regulations
• Experience with hospital reimbursement, payment calculations, healthcare financial data, or Medicaid payment methodologies
• Ability to review complex data, identify discrepancies, and develop accurate payment calculations
• Experience preparing technical documentation, analytical reports, payment models, and regulatory compliance documentation
• Strong communication and stakeholder coordination skills, including working with hospitals and government agencies
• Ability to manage multiple deliverables and complete assignments within established timelines

Benefits

• The majority of the work can be performed remotely within the Continental United States; occasional onsite work in Pierre, South Dakota, may be required.

Company Overview

Company H1B Sponsorship