Medicaid DSH Consultant

Overview:

• Seeking an experienced Senior Medicaid Disproportionate Share Hospital (DSH) Consultant to support a state Medicaid program in the analysis, administration, and calculation of DSH supplemental payments.
• The consultant will provide subject matter expertise in Medicaid reimbursement methodologies, federal and state regulatory compliance, hospital data analysis, payment calculations, and audit support.
• The role involves working with healthcare providers and Medicaid stakeholders to ensure accurate and timely DSH payment calculations, compliance with applicable regulations, and continuous improvement of program processes.
• DSH (Disproportionate Share Hospital) is a federal/state funding program that provides additional payments to hospitals serving significant numbers of Medicaid patients and uninsured individuals.

Responsibilities:

• Analyze federal policy changes, CMS guidance, and court decisions affecting Medicaid DSH programs.

• Evaluate DSH payment methodologies and recommend improvements to program processes.

• Support State Medicaid Plan reviews, updates, and resubmissions as required.

• Collect, validate, and analyze hospital financial, utilization, and Medicaid-related data used in DSH calculations.

• Calculate DSH payment amounts and develop annual payment models and schedules.

• Perform detailed healthcare reimbursement and financial analysis to support supplemental payment programs.

• Assist with DSH audits, regulatory compliance reviews, and related documentation.

• Identify and resolve data discrepancies in coordination with hospitals and Medicaid program staff.

• Develop provider education materials, training sessions, surveys, and communication plans.

• Communicate DSH methodologies, data requirements, and submission deadlines to participating hospitals.

• Prepare reports, supporting documentation, and final payment calculation deliverables.

• Ensure project deliverables are accurate and completed within established timelines.

Required Qualifications:

• Minimum 3 years of experience working with Medicaid Disproportionate Share Hospital (DSH) programs, including applicable rules, regulations, and related issues.

• Minimum 3 years of experience working with Medicaid rules, regulations, and policy requirements.

• Experience with Medicaid data analysis and reporting.

• Experience calculating healthcare reimbursement or supplemental payment programs.

• Experience validating, reconciling, and analyzing hospital financial and utilization data.

• Knowledge of Medicaid reimbursement methodologies, DSH payment calculations, and healthcare financial analysis.

• Experience with payment modeling and forecasting, data validation, and reconciliation.

• Knowledge of audit support, compliance reviews, and regulatory interpretation.

• Experience with hospital surveys, data collection, reporting, and documentation.

• Advanced Microsoft Excel skills.

• Understanding of Medicaid programs, DSH regulations, State Medicaid Plans, hospital reimbursement methodologies, CMS guidance, and healthcare supplemental payment programs.

Preferred Qualifications:

• Bachelor's or master's degree in Healthcare Administration, Public Health, Healthcare Finance, Finance, Economics, Accounting, Health Policy, or Business Administration.

• Experience supporting state Medicaid agencies.

• Experience with Medicaid supplemental payment programs.

• Experience working with healthcare consulting firms.

• Experience supporting CMS audits and compliance initiatives.

• Experience preparing State Plan Amendments (SPAs).

• Hospital cost reporting experience.

• Experience with both Managed Care and Fee-for-Service Medicaid.

• Experience with advanced Excel modeling, Microsoft Access, SQL, or healthcare data analytics tools.

• Familiarity with Medicaid Management Information Systems (MMIS) and healthcare reimbursement software.

• Background with Medicaid consulting firms, state Medicaid agencies, or hospital reimbursement consulting organizations.