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

Overview

The organization 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 provides direct client consulting and leadership, delivering objective advice and specialized expertise to help create value, maximize growth, and improve client business performance.

The Associate Director will support Directors and Senior Strategic Advisors (technical and non-technical) in delivering healthcare consulting services using policy and/or industry expertise across Medicaid policy, benefits, provider reimbursement, regulatory compliance, managed care, and business development. Senior-level client relationship ownership and responsibility for technical/policy aspects on projects are central to the role.

Responsibilities

• Manage assigned project tasks to maintain client satisfaction through proactive project management; take ownership of work and produce client-ready deliverables with minimal supervision.
• Provide subject matter expertise, consulting, and strategic services across multiple projects and clients.
• Support primary research and solution development, including proposal development support, project planning, data analysis, presentation development, and delivery of client presentations.
• Develop or oversee highly complex financial models for external and internal audiences, including dynamic models that allow users to manipulate assumptions and evaluate multiple scenarios.
• Apply Medicaid payment principles, including calculating federal and non-federal share of Medicaid payments; perform statistical testing; analyze public and private healthcare payer data.
• Use publicly available and proprietary data as needed.
• Establish and conduct robust Quality Assurance processes to ensure model accuracy.
• Safely manage and transfer client data and adhere to HIPAA.
• Build and maintain robust financial models to support strategic decision-making, forecasting, budgeting, and resource allocation.
• Serve as a key client contact for technical and financial questions and communications in the absence of, or as assigned by, a Director; act as primary contact for technical and financial aspects of projects.
• Interface directly with external client leadership (e.g., CEOs, CFOs, Reimbursement Directors) and state government officials (e.g., Medicaid Directors, Deputy Medicaid Directors, reimbursement teams, other department leads, Governor’s office, legislators) as well as stakeholders including CMS officials, state actuaries, state consultants, and trade associations.
• Leverage policy and healthcare solution expertise to help develop, document, and communicate new solutions.
• Participate in brainstorming and conceptualization with Directors, client leaders, and state government officials; collaborate with legal, regulatory, and compliance teams to ensure solutions meet legal and ethical standards.
• Stay abreast of evolving healthcare policies, regulations, and industry trends; use industry knowledge and insight to identify leads that may result in profitable revenue growth.
• Provide proposal development assistance, including drafting, editing, and scope development.
• Assist Medicaid Finance sales efforts to evaluate new targets through internal meetings, research, and the “sales assessment” process (on-site or virtual).
• Support budgeting and cost estimation, including accurate and comprehensive cost breakdowns to inform pricing strategies.
• Translate technical information for non-technical stakeholders and present technical aspects of solutions to prospective clients.
• Identify new business opportunities within assigned clients, enhance solutions for existing clients, and relay success stories or strategies to expand initiatives.
• Oversee the work of direct reports, including professional development, utilization planning, workload balancing, and regular check-ins to provide feedback and support career goals.
• Engage with clients to understand unique challenges and provide potential solutions and/or advice for Medicaid business goals; evaluate and refine solutions as Medicaid and the healthcare industry evolve.
• Perform ad hoc analyses regarding business investments and reimbursement methodologies in other markets that may indirectly or directly impact supplemental payments.
• Travel to client sites as required.

Financial SME Team Expectations (Specific to This Role)

• Interact with and inform client leaders in financial executive roles (e.g., 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 and state or federal laws.
• Maintain supporting data.
• Develop technical skills of direct reports.

Key Qualifications

• 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, including the 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 of Medicaid Waivers.
• Understanding of commercial reimbursement principles.
• Experience working with healthcare data such as claims sets and cost reports:
  • Experience developing dynamic models using large datasets.
  • Understanding of medical billing terminology and best practices.
  • Familiarity with Medicare Hospital Cost Reports for modeling and evaluation purposes.
  • Familiarity with publicly available data from CMS, such as physician fee schedules and public use files.
  • Familiarity with other publicly available healthcare datasets to inform modeling or projections.
  • Familiarity with data security and storage principles.
• Ability to provide mentorship and guidance to team members to develop technical skills and expertise.
• Experience with state Medicaid agencies, CMS, or healthcare providers preferred.
• Demonstrated success leading teams and managing complex projects.

Critical Professional Technical Skills

• 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.

Additional 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; experience in quantitative program evaluation is highly desirable.
• 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.

Compensation & Benefits

• Anticipated salary range: $127,600/year (lowest geographic market range) to up to $170,000/year.
• Final pay depends on factors that may include type and years of experience, type of years and experience within the industry, education, and market location.
• Typically, candidates are not hired near the top of the range.
• Eligible for an annual Corporate Incentive Plan (CIP) that can range to up to 15% of annual salary.
• Group healthcare plans (medical, dental, and vision) and insurance plans offering short term disability, long term disability, and basic life, subject to eligibility requirements under applicable plan documents.
• Eligibility to enroll in a 401k plan, subject to plan requirements.
• Flexible Time Off.
• 16 paid holidays throughout the calendar year.
• Paid time off for qualifying medical leave.
• Up to 12 weeks of combined paid parental and bonding leave.

Location

Not specified in the provided description.