Medicaid DSH Payment Analysis Specialist

TeleSolv Consulting is seeking an experienced DSH Analysis and Supplemental Payment Consultant to provide technical support and analytical expertise for a Government Medicaid Disproportionate Share Hospital, or DSH, supplemental payment program.

The consultant will assess regulatory and policy developments, evaluate program administration, collect and validate hospital data, calculate DSH rates and payments, and support program audits. The successful candidate must be able to perform detailed analytical work independently, communicate effectively with participating hospitals and Government stakeholders, and deliver accurate work within established deadlines.

Key Responsibilities

• Assess recent court decisions and federal policy changes or clarifications for their potential effect on the Government’s Medicaid program.
• Assess the appropriateness of State Plan resubmissions when necessary.
• Evaluate the current administration of DSH supplemental payments and recommend potential improvements.
• Support DSH program audits.
• Identify and collect the information and documentation required from qualified and eligible providers.
• Gather applicable data from eligible hospitals, the Government and other relevant sources.
• Review submitted data for reasonableness and accuracy.
• Work with hospitals and Government stakeholders to resolve data discrepancies.
• Calculate DSH rates and supplemental payments.
• Develop a draft DSH payment schedule for the upcoming state fiscal year.
• Calculate the DSH payment model for the year under review.
• Review and discuss draft payment-model results with Government stakeholders.
• Modify payment-model calculations when requested by the Government.
• Deliver final payment-model calculations in the format specified by the Government.
• Draft proposed communications to eligible hospitals concerning methodology, data collection and submission deadlines.
• Obtain Government approval before conducting outreach to participating hospitals.
• Develop and deliver education on DSH requirements, data sources, survey tools and documentation practices.
• Maintain project quality through proven standards and methodologies.
• Complete assigned work on schedule.

Skills, Knowledge & Expertise

• Knowledge of Medicaid data and healthcare payment information.
• Detailed understanding of DSH rules, regulations and related issues.
• Detailed understanding of Medicaid rules, regulations and related issues.
• Ability to interpret federal policy changes and relevant court decisions.
• Ability to collect, reconcile and validate data from multiple sources.
• Ability to identify and resolve discrepancies in hospital and Government data.
• Experience calculating payment rates, payment models and schedules.
• Ability to prepare clear communications for participating hospitals.
• Ability to explain technical DSH requirements, data sources and survey tools to stakeholders.
• Strong quality-control, documentation and time-management capabilities.
• Ability to work independently in a remote environment and travel on-site when required.

Qualifications

• Experience working with Medicaid data.
• At least three years of experience working with DSH rules, regulations and related issues.
• At least three years of experience working with Medicaid rules, regulations and related issues.
• Ability to perform remote work within the continental United States.
• Ability to work on-site in Pierre, South Dakota, for a limited portion of the engagement when required.