Medicaid Program Advisor - Cost Reporting

Staffing Solutions Organization LLC (SSO)-posted about 2 months ago

Full-time • Mid Level

Hybrid • Albany, NY

11-50 employees

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The Medicaid Program Advisor will support the New York Department of Health’s Office of Health Insurance Programs (OHIP), Division of Health Plan Contracting and Oversight (DHPCO), in the development and oversight of the Medicaid Managed Care and Managed Long-Term Care (MLTC) Cost Reporting. This position plays a central role in modernizing fiscal reporting systems and processes, integrating data automation and ensuring that managed care financial oversight aligns with evolving state and federal requirements. The Medicaid Program Advisor will lead initiatives to redesign financial data intake, streamline and automate analyses, enhance financial data analytics, and strengthen integration with the State’s information technology systems (e.g., NYS ITS and fiscal platforms) to support real-time financial monitoring and data-driven decision making.

Collaborate within OHIP with systems, rate setting and, fiscal policy teams as well as NYSITS, to rebuild Medicaid and MLTC cost report data structures, ensuring improved accuracy, automation, and analytical capacity.
Redesign cost reporting templates and submission processes to align with policy updates, fiscal reform initiatives, and data governance standards.
Lead implementation of new cost report tables, data validation tools, and automated reconciliation processes.
Coordinate across OHIP program areas to ensure improved fiscal reporting supports programmatic decision-making and policy evaluation.
Partner with NYS ITS and fiscal systems teams to enhance cost reporting data integration with enterprise databases and analytics environments.
Support development of business rules and logic for automated data validation, error tracking, and visualization tools.
Contribute to testing, documentation, and user training for modernized cost report applications.
Oversee the collection, review, and validation of MCO financial submissions, including Medical Loss Ratio (MLR) reporting, solvency monitoring, and cost allocation compliance.
Evaluate financial trends and fiscal health of Medicaid managed care plans; develop standardized dashboards and performance metrics for plan monitoring.
Conduct fiscal impact analyses and prepare ad-hoc financial reports for internal and external stakeholders.
Participate in managed care organization (MCO) reviews related to solvency, expansion, mergers, and acquisitions.
Review provider and management contracts for financial compliance with Public Health Law and DOH fiscal standards.
Supervise 1-2 staff within the fiscal oversight unit as the team grows.
Present complex financial data clearly to technical and non-technical audiences, including senior management and policy partners.

Education: Bachelor’s degree in accounting, finance, business administration, data analytics, information systems, or a related field is highly preferred.
Experience: Minimum of eight (8) years of progressively responsible work experience in healthcare finance, managed care, or government fiscal oversight.
Strong proficiency in Excel, Access, and SQL-based or BI data tools (e.g., PowerBI, Tableau, SAS Viya).
Demonstrated understanding of healthcare finance, cost allocation, and regulatory compliance.
Ability to analyze complex datasets and synthesize fiscal insights.
Excellent written and verbal communication skills; adept at preparing presentations and reports for diverse audiences.
Ability to engage cross-functionally with multiple internal and external teams and stakeholders.
Ability to manage multiple priorities and work both independently and collaboratively in a dynamic policy and systems environment.

Experience with Medicaid cost reporting, managed care financial analysis, or IT-enabled financial systems strongly preferred.
Demonstrated experience in data analysis, automation, or fiscal systems modernization is highly desirable.

Health, vision, and dental insurance
401(k) with discretionary employer match
Paid time off and holidays
Flexible spending accounts

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