Contract Duration: 2 Years (NO BENEFITS)
Work Arrangement: Primarily Remote, with Limited Onsite Work
Onsite Location: Pierre, South Dakota
We are seeking an experienced healthcare reimbursement and Medicaid consulting professional to provide technical analysis and support for the Disproportionate Share Hospital (DSH) supplemental payment program.
The consultant will support the evaluation, administration, calculation, and auditing of DSH payments for eligible hospitals. Responsibilities include reviewing federal and state Medicaid requirements, collecting and validating hospital data, calculating payment models, preparing payment schedules, and recommending improvements to existing program methodologies.
The successful candidate will collaborate with state stakeholders and participating hospitals to ensure accurate calculations, regulatory compliance, effective documentation, and timely completion of project deliverables.
Analyze relevant court decisions and changes or clarifications in federal policy to assess their potential impact on the Medicaid DSH program.
Evaluate the need for revisions or resubmissions to the State Medicaid Plan.
Assess current DSH program administration and recommend improvements, including potential changes to program size and scope.
Review applicable federal and state regulations and payment methodologies to support compliant program administration.
Collect required information and supporting documentation from eligible hospitals and other relevant sources.
Identify the data, records, and documentation needed to calculate DSH payments in accordance with applicable requirements.
Gather and validate data for the applicable review year.
Review submitted information for accuracy, completeness, and reasonableness.
Investigate and resolve data discrepancies in coordination with hospitals and state stakeholders.
Calculate DSH rates and supplemental payments using the applicable payment methodology.
Develop and refine payment models based on stakeholder feedback and approved requirements.
Prepare draft and final payment calculations in the required format.
Develop the DSH Payment Schedule for the upcoming state fiscal year.
Assist with DSH program audits and related documentation.
Review hospital data and supporting records for consistency with applicable federal and state rules.
Maintain appropriate documentation of data sources, calculation methodologies, assumptions, and results.
Support quality assurance activities to ensure accurate, consistent, and defensible payment calculations.
Develop proposed communications for eligible hospitals explaining payment methodologies, data collection requirements, and submission deadlines.
Submit communications to the appropriate state stakeholders for approval before distribution.
Provide education and guidance to participating hospitals regarding DSH eligibility, program requirements, data sources, and survey tools.
Share best practices for maintaining documentation that supports DSH eligibility and payment calculations.
Coordinate with hospitals to obtain missing information and resolve questions during the data collection process.
Prepare draft payment models for review and discussion with state stakeholders.
Incorporate approved modifications and requested revisions into payment calculations.
Deliver final payment models and supporting documentation according to established requirements.
Maintain project schedules, monitor milestones, and ensure deliverables are completed on time.
Apply established quality standards and methodologies throughout the project lifecycle.
Communicate findings, issues, risks, and recommendations clearly to relevant stakeholders.
Understanding of Medicaid program administration and healthcare reimbursement.
Knowledge of Disproportionate Share Hospital (DSH) supplemental payment programs.
Ability to interpret federal and state healthcare policies and payment requirements.
Experience with financial analysis, payment calculations, data validation, and reconciliation.
Strong analytical and problem-solving skills.
Ability to collect, review, and interpret complex data from multiple sources.
Experience preparing technical reports, payment models, and supporting documentation.
Strong written and verbal communication skills.
Ability to coordinate with healthcare providers, government stakeholders, and multidisciplinary teams.
Strong project management, organization, and quality assurance skills.