Note: The job is a remote job and is open to candidates in USA. The South Dakota Department of Social Services, Division of Medical Services, seeks a consultant to support its Medicaid Disproportionate Share Hospital (DSH) supplemental payment program. The role covers payment calculations, data validation, regulatory and audit analysis, payment model development, and guidance for eligible hospitals and state stakeholders.

Responsibilities

• Analyze federal and state Medicaid regulations, court decisions, and policy clarifications to assess their impact on South Dakota's DSH supplemental payment program
• Evaluate the need for and appropriateness of State Plan resubmissions and recommend necessary updates
• Review existing DSH program administration and recommend improvements to program structure, size, scope, and payment methodologies
• Assist the State with DSH program audits and related compliance activities
• Identify and collect required financial, operational, and supporting documentation from eligible hospitals and other relevant sources
• Review hospital-submitted data for accuracy, completeness, reasonableness, and compliance with applicable requirements
• Investigate and resolve data discrepancies in coordination with hospitals and the Department of Social Services
• Calculate DSH payment rates and supplemental payments in accordance with federal and state rules
• Develop, maintain, and validate DSH payment calculation models for the applicable review year
• Prepare draft DSH payment schedules for the upcoming State Fiscal Year
• Review draft payment models with DSS, incorporate requested modifications, and deliver final payment calculations in the required format
• Develop proposed communications for eligible hospitals regarding payment methodologies, data collection requirements, submission deadlines, and supporting documentation
• Prepare educational materials and provide guidance to DSH-eligible hospitals on program requirements, data sources, survey tools, and documentation best practices
• Identify required artifacts and supporting documentation to establish hospital eligibility and calculate payments
• Maintain project quality, documentation, and compliance with established standards and methodologies
• Coordinate with state stakeholders and participating hospitals to ensure deliverables are completed accurately and on schedule

Skills

• Minimum 3 years of experience working with Medicaid rules, regulations, policies, and related program issues
• Minimum 3 years of experience working with Disproportionate Share Hospital (DSH) rules, regulations, payment methodologies, and related compliance requirements
• Demonstrated experience working with Medicaid data, healthcare financial data, or hospital payment information
• Strong understanding of Medicaid DSH supplemental payment programs and applicable federal and state requirements
• Experience with healthcare data collection, validation, financial analysis, and payment calculations
• Ability to analyze regulatory changes, court decisions, and policy updates and assess their impact on Medicaid programs
• Experience preparing analytical reports, payment models, schedules, and supporting documentation
• Strong analytical, problem-solving, communication, and stakeholder management skills
• Ability to work with hospitals, government agencies, and other stakeholders to resolve data discrepancies
• Strong organizational skills and the ability to manage multiple deliverables within established deadlines
• Experience supporting state Medicaid agencies or public-sector healthcare programs
• Previous experience with hospital supplemental payment programs, DSH audits, or Medicaid State Plan amendments
• Experience developing Medicaid payment models and annual payment schedules
• Knowledge of hospital financial reporting, DSH eligibility documentation, and healthcare reimbursement methodologies
• Experience providing training or technical guidance to hospitals and healthcare providers
• Experience supporting regulatory compliance reviews and government program audits

Benefits

• Ability to work remotely within the Continental United States

Company Overview

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