Manager, Medicaid Financial Operations

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
• Manage provider enrollment and credentialing
• 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
• Aid communities in understanding and complying with state-specific estate recovery criteria, including applicable timelines and refund determination processes
• 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
• 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

Qualifications

• 3+ years of experience in Medicaid program administration, payer relations, or provider enrollment
• Familiarity with Medicaid Waiver programs in at least one state (IN, TX, FL and MN preferred)
• 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