Subject Matter Expert/ Associate Engagement Director, Ohio Medicaid/Healthcare Financing - Columbus, United States - Rippling

Description

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.

About the Role

Sellers Dorsey is seeking Subject Matter Expert (Associate Engagement Director) working remotely, ideally from Ohio, who will work primarily on Ohio Medicaid Financing engagements and manage Sellers Dorsey client engagements focused on Medicaid strategy and financing, managed care, and provider policy and reimbursement.

The Associate Engagement Director provides direct client consulting and leadership services including providing objective advice, expertise and specialized skills in healthcare policy, strategy and management with the aim of creating value, maximizing growth and/or improving the business performance of clients.

This role supports the Managing Directors, Directors and Senior Strategic Advisors (both technical and non-technical) in delivering healthcare consulting services leveraging policy and/or industry expertise in areas such as Medicaid policy, benefits, provider reimbursement, regulatory compliance, managed care, and general business development.

This role is responsible for client relationships at a senior level and/or responsible for all policy/technical aspects on projects.

This role also delivers strategic advice and counsel to our Sellers Dorsey business partners, states, private companies and various associations or unions.

The role is responsible for policy guidance, project management, client deliverables and satisfaction, and identification of new and expanded business activities.

Specific to the Financial SME team, Associate Directors are expected to interact with and inform client leadership in financial executive positions (i.e. CFOs, Reimbursement Directors); identify and understand current reimbursement methodologies; interpret existing financial records; identify alternative Medicaid financing approaches; develop recommendations based on changing State or federal regulations; develop interactive financial models informed by existing financing structures/ proposed financing structures; state or federal laws; maintain supporting data; travel to client as required; develop technical skills of direct reports.
Key Responsibilities

Perform assigned and agreed upon project tasks maintaining client satisfaction through proactive project management; takes ownership of work and produces "client-ready" deliverables with minimal supervision.

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

Financial Modelling:
Develop or oversee the development of highly complex financial models for external and internal audiences.

This may include the development of dynamic models that allow external or internal audiences to manipulate model assumptions to view multiple scenarios; following Medicaid payment principles; calculating federal and non-federal share of Medicaid payments; statistical testing; analysing public and private healthcare payer data; ability to use publicly available as well as proprietary data; establishing and conducting robust Quality Assurance processes to ensure model accuracy; ability so safely manage and transfer client data; adherence to HIPAA; Dedicate substantial time to building and maintaining robust financial models to support strategic decision-making as said models contribute to accurate forecasting budgeting and resource allocation.

Serve as primary contact for all technical and financial aspects of the project.

This includes interfacing directly with external client leadership (CEOs, CFOs, Reimbursement Directors) or state government officials (Medicaid Directors, Deputy Medicaid Directors, reimbursement team, other department leads, Governor's office, legislators) and other stakeholders (CMS officials, state actuaries, state consultants, trade associations).

Leverage policy and/or healthcare solution expertise to help Directors and/or Managing Directors develop, document and communicate new solutions; Actively participate in brainstorming and conceptualization sessions with Directors and/or Managing directors, client leaders and State government officials, trade associations; Collaborate with legal, regulatory, and compliance teams to ensure proposed solutions meet legal and ethical standards.

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.

Stay abreast of evolving healthcare policies, regulations, and industry trends.

Sales:
Actively provide proposal development assistance including proposal drafting, editing, scope development, and related duties as necessary.

Assist the Medicaid Finance sales team evaluate new targets through internal meetings, research and the "sales assessment" process (on-site or virtual).

Assist with budgeting and cost estimation and provide accurate and comprehensive cost breakdowns to support pricing strategies.

Translate technical information into a format understandable by non-technical stakeholders and showcase the technical aspects of solutions to potential clients.

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; identify opportunities for enhancing solutions to existing clients; relay success stories or strategies employed to expand initiatives.

Oversee the work of direct reports; provide professional development; manage direct report utilization; optimize resource allocation to balance workloads and ensure efficient use of team members' skills; meet regularly to provide constructive feedback and help direct reports improve their skills to be on track to achieve career goals.

Engage with clients to understand and provide potential solutions and/or advice to their unique challenges, goals, and objectives in their Medicaid business; provide ongoing evaluation and refinement to solutions to adapt to the evolving Medicaid business and healthcare industry.

Perform ad hoc analyses regarding business investments, reimbursement methodology in other markets that may indirectly or directly impact supplemental payments.

Key Qualifications

Bachelor's Degree in Public Policy, Public Administration, Public Health, Health Administration.

Advanced degree in Public Health, Health Administration, business, economics, accounting, finance or MBA or additional relevant experience in lieu of such advanced degree preferred.

Bachelor's degree and 10 or more combined years in a public healthcare policy management role and/or in the healthcare consulting industry.

10 or more years of progressively responsible work experience in health or human services policy or finance, consulting and/or in a healthcare service delivery environment and/or with a Medicaid managed care organization, or 5+ years of post-graduate, progressively responsible work experience in consulting or operational experience in health care and/or health policy research/analysis is required.

Ability to develop and clearly present complex data models to internal and external audiences.
Ability to interpret and communicate new and existing federal guidance.
Leadership and/or people management skills.
Understanding of Medicaid financing and payments, for example:

Ability to develop and design Medicaid payment programs such as managed care directed payment programs, graduate medical education, and physician upper payment limit demonstrations.

Ability to assess Medicaid payment program limitations such as the Medicaid disproportionate share hospital (DSH) payments and the Fee for Service upper payment limit (UPL) while maximizing potential payments.

General knowledge of value-based and quality considerations when developing and designing Medicaid payment programs.
Ability to develop and design state-wide or local provider assessment programs
Knowledge of CMS submission processes for healthcare taxes and payments.
Familiarity with State Plan Amendments and Pre-Prints and associated submission timelines and data requirements.
Understanding of existing CMS rulings and guidelines and ability to interpret new CMS rulings and guidelines.

Understanding of allowable sources of non-federal share including, but not limited to, inter-governmental transfers, provider assessments, and certified public expenditures.

General knowledge on Medicaid Waivers.
Understanding of commercial reimbursement principles.

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

Experience developing dynamic models using large datasets
Understanding of medical billing terminology and best practices
Familiarity with Medicare Hospital Cost Reports for modelling and evaluation purposes
Familiarity with publicly available data from CMS, such as physician fee schedules, public use files, etc.
Familiarity with other publicly available healthcare datasets to inform modelling or projections.
Familiarity to with data security and storage principles.

Ability to provide mentorship and guidance to team members, ensuring the development of technical skills and expertise.
Experience with state Medicaid agencies, CMS or healthcare providers preferred.
Demonstrated success in leading teams and managing complex projects.
High proficiency in Microsoft Word and Excel required and experience with querying languages (e.g. SQL) for large datasets preferred.
Other Requirements

Excellent oral and written communication skills, including relaying complex technical terms in an easy-to-understand manner.
Ability to analyze and interpret federal and state policies and regulations.
Ability to interact professionally with clients and other outside audiences.
Strong analytical and problem-solving skills required; experience in quantitative program evaluation is highly desirable.
The ability to work effectively independently and in teams.
Experience delivering services on several projects simultaneously.
Time management skills.
Can develop and implement strategies to integrate data analytics and insights into healthcare policy and management decisions.
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

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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