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Reimbursement Policy Lead - Senior Consultant 2
at Sellers Dorsey
Philadelphia, PA

Reimbursement Policy Lead - Senior Consultant 2
at Sellers Dorsey
Philadelphia, PA

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Description

Reimbursement Policy Lead - Senior Consultant 2

Description/Job Summary

Practice Information:

Sellers Dorsey is a leading healthcare consulting firm specializing in Medicaid financing, policy and operations. Our National Medicaid Financing Practice works with clients such as states, counties, health systems, safety net hospitals, academic medical centers, physicians, nursing facilities and medical schools navigate the opportunities to strengthen their Medicaid business through the conception, creation and implementation of programs designed to increase Medicaid reimbursement and leverage their unique capacities to deliver on the quality and value propositions growing in Medicaid.  Our teams work together to ensure that technical, policy and political solutions are created to ensure successful results for our clients, particularly in the area of Medicaid financing.

Position Description:

The Reimbursement Policy Lead – Senior Consultant (II) provides direct client consulting services including objective advice, expertise and specialized skills in healthcare reimbursement, policy, and management. Reimbursement Policy Leads – Senior Consultant (II) support Project Directors as key members of the project team in delivering consulting services by leveraging policy and/or financial expertise in areas such as Medicaid financing and revenue maximization, provider reimbursement (physician, hospital, other), state and federal Medicaid reimbursement policy, healthcare taxes, intergovernmental transfers, navigating the shift to value-based payment and/or provider operations. Reimbursement Policy Leads – Senior Consultant (II) are responsible for policy guidance, direct service delivery, development of financial estimates, understanding state and federal reimbursement systems, helping clients manage new programs, client satisfaction and new business activities, including attending prospective client meetings.

Responsibilities/Duties

Key Responsibilities/Outcomes:

General Responsibilities and Expectations

  • Reimbursement Policy Leads – Senior Consultant (II) are expected to account for hours on a monthly basis. They will be assigned to client project teams and will also spend time on sales and marketing and administrative activities, as needed.  Reimbursement Policy Leads – Senior Consultant (II) are expected to review periodic activity reports and work with their supervisors to develop strategies to ensure targets are met.
  • Sellers Dorsey Reimbursement Policy Leads – Senior Consultant (II) are expected to travel as needed to meet the needs of client servicing, marketing, and business development. National travel up to 50% may be required.  Reimbursement Policy Leads – Senior Consultant (II) understand that work may require periodic availability on weekends and nights
  • Reimbursement Policy Leads – Senior Consultant (II) are responsible for keeping current on the changing federal regulatory environment, learning state specific regulations to support assigned projects, and staying current on industry trends.

Consulting Services

  • Depending upon specific areas of expertise, assume significant levels of responsibility on a diverse range of projects and project tasks; develop consulting expertise that can be replicated in future projects
  • Manage all technical aspects of Medicaid financing initiatives
  • Perform assigned and agreed upon project tasks maintaining client satisfaction; takes ownership of work and assists in the development of “client-ready” deliverables
  • Deliver subject matter expertise and consulting services for multiple clients/projects, clients and engagements; manage assigned primary research and/or solution development; assist with proposal development, project plan development, data analysis and modeling, presentation development, and delivery of client presentations
  • May serve as a key client contact to respond to questions, provide required communications and be responsible for a successful client engagement

Business Development

  • 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
  • Actively provide proposal development assistance including proposal drafting, editing, scope development, and related duties and participate in sales meetings, as necessary
  • 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
  • In coordination with the marketing team, produce and review content for selected internal and external marketing tools, such as Firm newsletters, conference presentations, website content, and marketing webinars, to highlight the Firm’s capabilities, subject matter expertise and successes

Knowledge Management

  • Leverage policy and/or healthcare solution expertise to help the Firm develop, document and communicate new solutions

Required Qualifications

Key Qualifications:

Education and Work Experience

  • Bachelor's degree and 5+ or more combined years in Medicaid, provider reimbursement and/or in the healthcare consulting industries
  • Understanding of Medicaid financing and payments
  • Experience working with healthcare data such as claims sets, cost reports, etc.
  • Experience in Medicaid agency, CMS or healthcare providers preferred.
  • Experience with value-based payment arrangements preferred

Skills

  • Extensive practical knowledge and application of Medicaid reimbursement rules
  • Ability to perform all the technical functions of a Medicaid financing initiative including but not limited to:
    • assess potential Medicaid supplemental payments and related transactions in states where Reimbursement Policy Lead – Senior Consultant (II) may not have prior knowledge
    • utilize cost reports and other large datasets to drive decision points within a project
    • determine all the steps needed to execute a Medicaid financing initiative
    • provide detailed data analysis, models and summaries of the financial impact from policy or methodology changes
    • calculate upper payment limits for a variety of providers and provider classes under the Medicaid program
    • estimate the potential federal funds generated by an initiative as well as the transaction costs
    • assess project data needs and collect the data necessary to carry out the above activities
    • respond to questions and inquiries by the Centers for Medicare and Medicaid Services (CMS) and keep track of recent CMS decisions and decision-making procedures
    • assist clients in developing policies, procedures and structures required to implement the project
    • understanding of the connection between reimbursement, quality and value at both the state and provider levels
    • provide subject matter expertise related to Medicaid managed care, rate development, metrics related to clinical or financial measurement
  • High proficiency in Microsoft Word, Excel, Access required
  • Simultaneously balance the needs and timeliness of many projects
  • Work closely with the project director and project managers to draft public notices, state plan amendments, 438.6(c) preprints, waiver amendments, memos, workplans, and external or internal progress reports, client-ready spreadsheets and calculations
  • Provide technical leadership and explanation to multiple levels of the organization to build internal capacity and foster knowledge management
  • Excellent oral and written communication skills including relaying complex technical terms in an easy to understand manner. This includes producing written or pictorial materials for external and internal use and to present calculations in a manner that the client or other staff can reasonably follow
  • Ability to interact professionally with clients and other outside audiences
  • Work with legal counsel when necessary in designing new payment initiatives
  • Attention to detail
  • Ability to work independently and in teams
  • Time management skills

Details

Core Behaviors and Competencies:

  • Build positive relationships within and outside the Firm
  • Treat clients, strategic partners and fellow employees with respect and professionalism in all interactions
  • Take ownership for one’s professional development by increasing knowledge, skills and abilities in areas that are critical to the Firm’s success
  • Collaborate and share knowledge with other Firm staff
  • Demnstrate formal and ad hoc team leadership in projects, issues or organizations that are critical to achieving the Firm’s strategic goals
  • Be self-motivated, and be an advocate for one’s abilities and talents, both internally and externally

Key Performance Metrics/Expectations:

  • Individual performance goals
  • Successful completion of deliverables, tasks, projects
  • Professional development

We are an Equal Employment/Affirmative Action employer. We do not discriminate in hiring on the basis of sex, gender identity, sexual orientation, race, color, religious creed, national origin, physical or mental disability, protected Veteran status, or any other characteristic protected by federal, state, or local law.

If you need a reasonable accommodation for any part of the employment process, please contact us by email at reasonableaccommodations@sellersdorsey.com and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this e-mail address.

For more information, view the EEO is the Law Poster and Pay Transparency Statement.

 

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