Senior Consultant - Medicaid Reimbursement

Overview

Health Management Associates is looking for a Senior Consultant in the Medicaid space. This role requires strong Medicaid policy and reimbursement experience along with a strong understanding of CMS regulations governing Medicaid reimbursement to hospitals, nursing homes, and physicians. We are seeking a professional with experience modeling and analyzing CMS Medicaid upper payment limit demonstrations, designing and implementing Medicaid supplement payment programs (Examples include: Medicaid DSH and graduate medical education payments) along with designing and modeling Medicaid provider taxes for state Medicaid agencies or providers. In addition to the requirements below, the ideal candidate will have prior experience working on state directed payment programs including understanding CMS policy governing such programs and experience completing and analyzing CMS preprints and experience drafting and/or reviewing Medicaid state plan amendments.

Job Summary

Working with clients, the Senior Consultant provides expertise to help organizations through healthcare-related research, technical assistance, grant writing, policy analysis, strategic planning, procurements, program development, quality improvement, financial and reimbursement strategies, operational support, evaluation, product development and a range of other tasks. As an experienced expert within the firm, the Senior Consultant is responsible for client services, project management, and supporting the firm’s efforts to develop business through participation in the competitive and/or non-competitive proposal development process.

Responsibilities

Work Performed

• Client management
  • Meets with clients and colleagues to understand requirements.
  • Gathers and organizes information about the issue to be solved or the procedure to be improved.
  • Analyzes data to identify and understand issues to be addressed.
  • Presents findings to internal colleagues, and clients.
  • Provides advice, implementation plans, and/or suggestions for improvement, according to project objectives.
  • Evaluates client needs, as warranted, and adjusts as appropriate.
  • Ensures that all deliverables are high-quality in all aspects (content, grammar, presentation, etc.).
• Serves as a subject matter expert on projects.
• Project management
  • Undertakes internal and external short-term and/or long-term project management to address identified issues and needs.
  • Develops and documents tools, analysis, frameworks, tracking tools, road maps, dashboards, and/or other approaches to manage a variety of large and small projects.
• Business development
  • Supports firm business development activities to expand funded work from existing clients and/or new clients.
  • Develops and maintains a pipeline of future work
  • Participates in competitive and/or non-competitive proposal development and submission.
• Leadership
  • Leads and manages teams, provides developmental feedback, and advances internal initiatives.
  • Serves as a mentor for other staff members, as requested.
• Performance metrics
  • Ensures performance meets or exceeds HMA expectations in the following areas:
    • Billable hour target attainment.
    • Manages to budget/project caps established at the outset or assists in negotiating additional fees.
    • Meets quality and operational standards.
    • Participates in internal activities related to business strategies, forecasts, adoption of new technologies/platforms/approaches, and other process improvements.
• Completes administrative requirements of the role in a punctual manner, including training, reporting, timesheets, expense reports, forecasting, and all other time-sensitive administrative duties.
• All other duties as assigned.

Qualifications

Education/Training

Bachelor’s degree in Business Management, Public Health, or a related discipline is required. Equivalent work experience in lieu of a bachelor’s degree, although not desired, may be determined as acceptable. A Master’s degree in a related discipline is strongly preferred.

Experience

At least 5 years of progressively increasing prior experience in work involving publicly-funded healthcare including, but not limited to policy, administration, operations, compliance, research, consulting, or evaluation.

Knowledge, Skills and Abilities

• Strong project management skills.
• Solid time management skills.
• Excellent attention to detail.
• Ability to multi-task and adhere to strict deadlines.
• Capable of handling confidential information in a discreet manner.
• Ability to work extended hours when deadlines are approaching.
• Excellent internal and excellent professional networking skills.
• Excellent critical thinking skills.
• Exceptional oral and written communication skills.
• Superior interpersonal skills, including leadership, contribution to culture, and acceptance of accountability.
• Demonstrated thought leadership and deep expertise in more than one critical healthcare area.
• Ability to maintain an approach to stay current in trends in areas of subject matter expertise.

Work Aids and Equipment Used

Computer, printer, copier, scanner, fax, telephone, web conferencing.

Working Conditions

Work is sedentary in nature and performed in an office environment. Frequent travel to client sites and HMA offices. Involves frequent contact with staff and clients. Work may be stressful at times

Physical/Mental Demands

Work requires hand dexterity for office machine operation; stooping, climbing, and bending to files and supplies; mobility to complete errands; stand/sit for up to eight hours each day; ability to communicate clearly when using the telephone; requires sitting; standing, walking, reaching, bending, lifting, and twisting at times; moderate levels of stress.

EEO

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)