Medicaid Disproportionate Share Hospital (DSH) Payment Analyst

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Posted Oct 30, 2026

Remote · US Contract

$25 – $30/hr

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Overview

This contract position is for a Medicaid Disproportionate Share Hospital (DSH) Payment Analyst supporting a state Medicaid agency’s DSH supplemental payment program. The work is performed remotely within the continental United States, with occasional travel to Pierre, SD. A two-year engagement is expected to begin June 2027, with possible extension.

Responsibilities

Assess recent court decisions and changes or clarifications in federal DSH policy, and advise the state on potential impacts to the Medicaid program and State Plan.
Determine whether State Plan resubmissions are needed and support their preparation.
Evaluate how DSH supplemental payments are administered and recommend improvements, including potential changes to program size and scope.
Identify the artifacts, information, and documentation required to calculate DSH payments under federal and state rules.
Draft proposed communications to eligible hospitals describing methodology, data collection process, and submission deadlines for state approval before outreach.
Collect and review data for the year under review from eligible hospitals, the state, and other sources; validate for reasonableness and accuracy; resolve discrepancies with hospitals and the state.
Calculate DSH rates and payments by building the payment model for the year under review; review with the state, incorporate requested modifications, and deliver final calculations in the format specified by the state.
Draft the DSH payment schedule for the upcoming state fiscal year.
Support DSH program audits by responding to auditor requests and reconciling data.
Develop and deliver education for DSH-eligible hospitals on DSH requirements, data sources, survey tools, and best practices for documenting DSH eligibility.
Keep work activities on schedule and aligned with proven standards and methodologies.

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Required Qualifications

At least three years of experience working with Medicaid DSH rules, regulations, and related issues, including DSH payment calculations, DSH audits, or hospital DSH survey work.
At least three years of experience working with Medicaid rules, regulations, and related issues, including State Plan payment methodologies.
Hands-on experience working with Medicaid data (e.g., claims, eligibility, or payment data).
Advanced Excel skills for building and documenting payment models; SQL or SAS for data validation is a plus.
Ability to clearly explain DSH methodology to hospital finance staff and state program staff in writing and during training sessions.
Availability for a two-year engagement beginning about June 2027 and for occasional travel to Pierre, SD.
Three professional references who can speak to Medicaid DSH or Medicaid payment work.
Must currently reside in the continental United States. Visa sponsorship is available for qualified candidates.

Preferred Qualifications

Experience with a state Medicaid agency, a Medicaid financing or reimbursement consulting firm, or a hospital association on DSH or other supplemental payment programs.
Experience with hospital cost report data, including Medicare cost report (CMS 2552) data, and uncompensated care data.
Experience with federal DSH audit and reporting requirements under 42 CFR 455 Subpart D and the hospital-specific DSH limit.
Experience with other Medicaid supplemental payment programs, such as upper payment limit or directed payments.
CPA, MHA, or a related degree in health administration, accounting, or finance.