Subject Matter Expert/ Associate Director, Medi-Cal/California Medicaid Financing

California, MO, United States

About Sellers Dorsey

Sellers Dorsey is a leading and fast-growing national healthcare consulting firm specializing in Medicaid financing, policy, and operations. We deliver impactful outcomes for our clients with a combination of technical expertise and deep understanding of public policy, government, and national and local political landscape. Together with its clients, Sellers Dorsey realizes opportunities that enhance the bottom-line and ultimately improve the lives of people and is committed to expanding access to healthcare in the US.

Our National Medicaid Financing Practice works with clients such as states, counties, health systems, safety net hospitals, academic medical centers, physicians, nursing facilities and medical schools navigate the opportunities to strengthen their Medicaid business through the conception, creation and implementation of programs designed to increase Medicaid reimbursement and leverage their unique capacities to deliver on the quality and value propositions growing in Medicaid. Our teams work together to ensure that technical, policy and political solutions are created to ensure successful results for our clients, particularly in the area of Medicaid financing.

About the Role

Sellers Dorsey is seeking a Subject Matter Expert/Associate Director working remotely who will assist the team by leveraging deep knowledge of policy and/or financial expertise in areas such as California Medicaid financing and revenue maximization, provider reimbursement (physician, hospital, other), state and federal Medicaid reimbursement policy, healthcare taxes, intergovernmental transfers, and navigating the shift to value-based payment and/or provider operations. They are responsible for policy guidance, development of financial estimates and understanding state and federal reimbursement systems.

The Subject Matter Expert/Associate Director is a key member of the client servicing team, helping implement and manage new programs for clients and ensuring a high level of satisfaction. In addition to client servicing, the Subject Matter Expert/Associate Director assists the sales team by identifying new business opportunities, expanding existing engagements and participating in sales activities, including attending prospective client meetings.

Responsibilities/Duties

General Responsibilities and Expectations

Account for hours on a monthly basis. You will be assigned to client project teams and will also spend time on sales and marketing and administrative activities, as needed. You are expected to review periodic activity reports and work with their supervisors to develop strategies to ensure targets are met.

Travel as needed to meet the needs of client servicing, marketing, and business development. National travel up to 25% may be required.

Understand that work may require periodic availability on weekends and nights.

Responsible for keeping current on the changing federal regulatory environment, learning state specific regulations to support assigned projects, and staying current on industry trends.

Consulting Services

Depending upon specific areas of expertise, assume significant levels of responsibility on a diverse range of projects and project tasks; develop consulting expertise that can be replicated in future projects.

Manage all technical aspects of Medicaid financing initiatives.

Perform assigned and agreed upon project tasks maintaining client satisfaction; takes ownership of work and assists in the development of “client-ready” deliverables.

Deliver subject matter expertise and consulting services for multiple clients/projects, clients and engagements; manage assigned primary research and/or solution development; assist with proposal development, project plan development, data analysis (SQL) and modeling, presentation development, and delivery of client presentations.

May serve as a key client contact to respond to questions, provide required communications and be responsible for a successful client engagement

Business Development

Use personal industry knowledge, connections, business expertise, public policy awareness and political insight to identify leads that could result in profitable revenue growth for the Firm.

Actively provide proposal development assistance including proposal drafting, editing, scope development, and related duties and participate in sales meetings, as necessary.

Actively seek to identify new business opportunities for the Firm within assigned clients to help maximize long term benefits and relationship between the client and Sellers Dorsey.

In coordination with the marketing team, produce and review content for selected internal and external marketing tools, such as Firm newsletters, conference presentations, website content, and marketing webinars, to highlight the Firm’s capabilities, subject matter expertise and successes.

Knowledge Management

Leverage policy and/or healthcare solution expertise to help the Firm develop, document and communicate new solutions.

Required Qualifications :

Education and Work Experience

Bachelor's degree and 10 or more combined years in Medicaid, provider reimbursement and/or in the healthcare consulting industries.

Experience and understanding of California Medicaid financing and payments is a must.

Experience working with healthcare data such as claims sets, cost reports, etc.

Experience in Medicaid agency, CMS or healthcare providers preferred.

Experience with value-based payment arrangements preferred.

SQL knowledge/experience preferred.

Skills

Extensive practical knowledge and application of Medicaid reimbursement rules

Ability to perform all the technical functions of a Medicaid financing initiative including but not limited to: Assess potential Medicaid supplemental payments and related transactions in states where Consultant, Senior Strategic Advisor may not have prior knowledge.

Utilize cost reports, disproportionate share (DSH) reports and other large datasets to drive decision points within a project.

Determine all the steps needed to execute a Medicaid financing initiative.

Provide detailed data analysis (SQL), models and summaries of the financial impact from policy or methodology changes.

Calculate upper payment limits for a variety of providers and provider classes under the Medicaid program.

Estimate the potential federal funds generated by an initiative as well as the transaction costs.

Assess project data needs and collect the data necessary to carry out the above activities.

Respond to questions and inquiries by the Centers for Medicare and Medicaid Services (CMS) and keep track of recent CMS decisions and decision-making procedures.

Assist clients in developing policies, procedures and structures required to implement the project.

Understanding of the connection between reimbursement, quality and value at both the state and provider levels.

Provide subject matter expertise related to Medicaid managed care, rate development, and metrics related to clinical or financial measurement.

Serve as a mentor to junior staff, leveraging as appropriate to execute client deliverables.

High proficiency in Microsoft Word, Excel, Access required.

Simultaneously balance the needs and timeliness of many projects.

Work closely with the project director and project managers to draft public notices, state plan amendments, 438.6(c) preprints, waiver amendments, memos, workplans, and external or internal progress reports, client-ready spreadsheets and calculations.

Provide technical leadership and explanation to multiple levels of the organization to build internal capacity and foster knowledge management.

Excellent oral and written communication skills including relaying complex technical terms in an easy to understand manner. This includes producing written or pictorial materials for external and internal use and to present calculations in a manner that the client or other staff can reasonably follow.

Ability to interact professionally with clients and other outside audiences.

Work with legal counsel when necessary in designing new payment initiatives.

Ability to work independently and in teams.

Core Behaviors and Competencies:

Build positive relationships within and outside the Firm.

Treat clients, strategic partners and fellow employees with respect and professionalism in all interactions.

Take ownership for one’s professional development by increasing knowledge, skills and abilities in areas that are critical to the Firm’s success.

Collaborate and share knowledge with other Firm staff.

Demonstrate formal and ad hoc team leadership in projects, issues or organizations that are critical to achieving the Firm’s strategic goals.

Be self-motivated, and be an advocate for one’s abilities and talents, both internally and externally.

Key Performance Metrics/Expectations :

Individual performance goals.

Successful completion of deliverables, tasks, projects

The salary range for this California-based and fully remote role is up to $200,000 and represents the firm’s good faith and reasonable estimate of the range of possible compensation at the time of posting. Actual compensation will depend upon a number of factors, including but not limited to, the candidate’s years of experience in relevant positions, qualifications, skill set and locations. Discretionary bonuses may be awarded in recognition of individual and firm performance. It is not typical for an individual to be hired near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.

We are an Equal Employment/Affirmative Action employer. We do not discriminate in hiring on the basis of sex, gender identity, sexual orientation, race, color, religious creed, national origin, physical or mental disability, protected Veteran status, or any other characteristic protected by federal, state, or local law.

If you need a reasonable accommodation for any part of the employment process, please contact us by email at [email protected] and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this e-mail address. For more information, view the EEO is the Law Poster and Pay Transparency Statement .

This position requires that you be fully vaccinated against Covid-19. Requests for reasonable accommodation on the basis of disability and/or sincerely held religious beliefs will be provided subject to undue hardship.

Sellers Dorsey maintains a Drug-Free workplace.

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