Manager, Medicaid Financial Operations

Sonida Senior Living•Addison, TX

About The Position

This role serves as the organization's dedicated subject matter expert on Medicaid Waiver programs across all operating states. As Medicaid regulations, reimbursement structures, and managed care environments continue to evolve rapidly, this specialist will ensure our communities stay current, compliant, and connected to the right payer relationships. The ideal candidate brings deep knowledge of state-specific Medicaid policy and a track record of managing provider enrollment, contracting, and regulatory compliance in a multi-site healthcare or senior living setting.

Requirements

3+ years of experience in Medicaid program administration, payer relations, or provider enrollment
Working knowledge of Medicaid Waiver programs in at least one state (IN, TX, FL and MN preferred)
Familiarity with NPI/LPI enrollment processes
Strong organizational and project management skills
Ability to interpret and summarize regulatory and legislative documents
Proficiency in Microsoft 365
Experience in senior living, long-term care, or home and community-based services (HCBS)
Background in MCO/MCE contracting or rate negotiation
Familiarity with Medicaid cost reporting
Experience working in or alongside a multi-site operations environment

Responsibilities

Monitor and track Medicaid legislation, policy changes, and procedure updates across all operating states on an ongoing basis
Translate regulatory changes into actionable guidance for community leadership and operations teams
Maintain current knowledge of allowed room and board rates by state, including MA-SS income calculations and personal needs allowance (PNA) amounts
Research and document Medicaid Waiver program details for new states as the organization expands
Manage the renewal of existing Medicaid contracts to ensure continuous participation and compliance
Establish new contracts with Managed Care Entities (MCEs) and Managed Care Organizations (MCOs) as needed
Negotiate reimbursement rates with payers (where applicable)
Maintain a centralized contract tracking system to monitor expiration dates, rate changes, and renewal timelines
Research and verify existing National Provider Identifier (NPI) and Local Provider Identifier (LPI) numbers for current communities
Apply for new NPIs and LPIs as needed for new or expanding communities
Support communities in applying to become approved Medicaid Waiver providers, including data gathering and application coordination
Maintain accurate and up-to-date provider enrollment records across all states
Assist community and finance teams with data needed for Medicaid cost reports
Maintain working knowledge of state-specific estate recovery criteria, including applicable timelines and refund determination processes (resident vs. state)
Track and communicate legislative developments that may affect estate recovery windows (e.g., timeline extension initiatives)
Obtain and distribute updated Medicaid reimbursement rates to relevant stakeholders in a timely manner
Serve as a resource and thought partner for community leadership navigating Medicaid Waiver program requirements
Identify knowledge gaps across communities and develop tools or resources to close them
Collaborate cross-functionally with operations, finance, and compliance teams to align on Medicaid-related processes
Directly supervise billing specialist(s), providing day-to-day direction, support, and accountability
Oversee the accuracy and timeliness of Medicaid billing activities, reviewing work product and resolving escalated issues
Coordinate closely with the Billing Specialist(s) on claims submission, payment reconciliation, and billing-related compliance requirements
Onboard and train the Billing Specialist(s) on Medicaid program processes, payer requirements, and compliance expectations