Title:  DVHA Program Consultant - Limited Service

Overview

The Department of Vermont Health Access (DVHA) Coordination of Benefits (COB) Unit is seeking a skilled and knowledgeable Health Care professional to join the COB Recoveries team. Have the work/life balance you need with a Monday-Friday schedule and a supportive hybrid work environment. Twelve paid state holidays, in addition to a robust benefits package.
The Program Consultant role serves as the subject matter expert for the following work processes with the COB Recoveries Team:
· Centers for Medicare & Medicaid (CMS) Enterprise Portal for:
o Medicare Advantage Prescription Drug (MARx user interface)
o Eligibility and Enrollment Medicare Online (ELMO) 
· Casualty Recoveries
· Choices for Care Long-Term Care Patient Share Recoveries
· Choices for Care Long-Term Care Over Resource Recoveries
· Estate Recoveries
· Annuity & Trust Recoveries

The Program Consultant position has the following responsibilities:
· Case management and accounting for all COB Recoveries areas
· Collaborating with internal and external stakeholders.
· Interpreting and applying complex billing and coding rules
· Interpreting and applying complex health care eligibility rules for multiple programs
· Conducting research and analysis on eligibility issues
· Overseeing procedural development.
· Ensuring compliance with federal and state regulations.
· Conducting research and analysis on policy rules
· Conducting research and analysis on third-party liability rules
· Managing escalated cases.
· Supporting system enhancements and compliance.
· Contributing to policy development, special projects, program evaluation, and the creation of standard operating procedures and training materials.
 
Key Skills & Competencies:
· Subject Matter Expertise: Advanced knowledge of health care program rules and business processes, with the ability to interpret and apply regulations accurately.
· Consultative & Evaluative Skills: Ability to evaluate policies, procedures, and regulations and recommend improvements based on program analysis.
· Analytical & Problem-Solving Skills: Strong analytical skills for reviewing complex legal and regulatory documents, as well as resolving escalated cases.
· Collaboration & Communication: Excellent communication skills, both verbal and written, with the ability to liaise effectively with a wide range of stakeholders, including department staff, external partners, and policy analysts.
· Project Management: Experience managing special projects, working under tight deadlines, and ensuring that program outcomes are met in a timely and efficient manner.
· Adaptability: Ability to work in a fast-paced environment, balancing multiple tasks and responsibilities while maintaining attention to detail and accuracy.

Mission:
The Department of Vermont Health Access (DVHA)'s mission is to improve Vermonters' health and well-being by providing access to high-quality, cost-effective health care. We have identified three priorities that support our mission: Advancing value-based payments, modernizing information technology infrastructure, and operational performance improvement. Our department commits to executing our responsibilities and priorities while adhering to three core values: Transparency, Integrity and Service.
 
Diversity, Equity, and Inclusion:
As part of our values of transparency, integrity, and service, we are committed to supporting diversity, equity, inclusion, and accessibility as part of our person-centered culture. We actively celebrate our colleagues' and future colleagues' different abilities, racial identity, sexual orientation, ethnicity, age, and gender. Everyone is welcome and supported here.

Who May Apply

This position, DVHA Program Consultant - Limited Service (Job Requisition #55933), is open to all State employees and external applicants. It is a Limited Service position, which is non-tenured and authorized for a specific period of time. Limited Service positions are established for specially funded projects or programs. 
If you would like more information about this position, please contact Samantha.Wolcott@vermont.gov
Resumes will not be accepted via e-mail.  You must apply online to be considered.
Please note that multiple positions in the same work location may be filled from this job posting.

AHS BACKGROUND CHECKS:  Candidates must pass any level of background investigation applicable to the position.  In accordance with AHS Policy 4.02, Hiring Standards, Vermont and/or national criminal record checks, as well as DMV and adult and child abuse registry checks, as appropriate to the position under recruitment, will be conducted on candidates, with the exception of those who are current classified state employees seeking transfer, promotion or demotion into an AHS classified position or are persons exercising re-employment (RIF) rights.

Environmental Factors

Work is generally performed within the normal office setting.

Some means of private transportation must be available for field visits. Work activities during the evening or weekend may occur, and some out-of-state travel may be required. Conflicting opinions relative to the correct application of rules, regulations and policies can be anticipated.

Minimum Qualifications

Two (2) years or more of experience in a healthcare or health insurance field with experience in either accounting, auditing, federal grants management, business administration or public or health administration. 

Preferred Qualifications

Bachelor's degree AND one (1) year or more of experience in a healthcare or health insurance field. 

Experience in either accounting, auditing, federal grants management, business administration or public or health administration.

Total Compensation

As a State employee you are offered a great career opportunity, but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits that are worth about 30% of your total compensation, including:

•     80% State paid medical premium and a dental plan at no cost for employees and their families
•     Work/Life balance: 12 paid holidays each year and a generous leave plan
•     State Paid Family and Medical Leave Insurance (FMLI)
•     Two ways to save for your retirement: A State defined benefit pension plan and a deferred compensation 457(b) plan
•     Tuition Reimbursement
•     Flexible spending healthcare and childcare reimbursement accounts
•     Low cost group life insurance
•     Incentive-based Wellness Program
•     Qualified Employer for Public Service Student Loan Forgiveness Program

Want the specifics? Explore the Benefits of State Employment on our website.

Equal Opportunity Employer