Associate Director, Healthcare Finance (Medicaid Strategy & Financing, Managed Care and Policy & Reimbursement)

Sellers Dorsey

5d•$127,600 - $170,000•Hybrid

About The Position

Sellers Dorsey is seeking an Associate Director, Healthcare Finance to manage client engagements focused on Medicaid strategy and financing, managed care, and provider policy and reimbursement. This role involves providing direct client consulting and leadership services, offering objective advice, expertise, and specialized skills in healthcare policy, strategy, and management to enhance client value, growth, and business performance. The Associate Director will support Directors and Senior Strategic Advisors in delivering consulting services, leveraging expertise in Medicaid policy, benefits, provider reimbursement, regulatory compliance, managed care, and business development. Key responsibilities include managing senior-level client relationships, overseeing policy/technical aspects of projects, delivering strategic advice to business partners, states, private companies, and associations, and managing policy guidance, project management, client deliverables, satisfaction, and identifying new business opportunities. Specific to the Financial SME team, the role requires interacting with client leadership (CFOs, Reimbursement Directors), understanding reimbursement methodologies, interpreting financial records, identifying alternative Medicaid financing approaches, developing recommendations based on regulations, creating financial models, maintaining data, traveling to clients, and developing direct reports' technical skills.

Requirements

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 with data security and storage principles
Ability to provide mentorship and guidance to team members, ensuring the development of technical skills and expertise.
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.
Ability to develop and implement strategies to integrate data analytics and insights into healthcare policy and management decisions.

Nice To Haves

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.
Experience with querying languages, such as SQL, for large healthcare datasets preferred.
Familiarity with approved AI-enabled tools to support Medicaid finance research, data analysis, financial modeling, proposal development, and quality review preferred, with required validation of AI-assisted outputs for accuracy, regulatory relevance, and client confidentiality.

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.
Develop or oversee the development of highly complex financial models for external and internal audiences, including dynamic models for scenario analysis, following Medicaid payment principles, calculating federal and non-federal share of Medicaid payments, statistical testing, analyzing public and private healthcare payer data, using publicly available and proprietary data, establishing and conducting Quality Assurance processes, safely managing and transferring client data, adhering to HIPAA, and building/maintaining robust financial models for forecasting, budgeting, and resource allocation.
In the absence of, or as assigned by a Director, may serve as a key client contact to respond to questions, provide required communications and be responsible for a successful client engagement. 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 develop, document and communicate new solutions; Actively participate in brainstorming and conceptualization sessions with 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.
Actively provide proposal development assistance including proposal drafting, editing, scope development, and related duties as necessary. Assist the Medicaid Finance sales team to 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.