Remote Medicaid Waiver Operations Lead Senior Living

Sonida Senior Living is one of the nation’s leading operators of independent living, assisted living and memory care communities for senior adults. The Company operates 165 communities that are home to nearly 12,000 residents across 35 states providing comfortable, safe, affordable communities where residents can form friendships, enjoy new experiences and receive personalized care from dedicated team members who treat them family. Job Description : 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. *This position can be performed either remotely or from our Dallas, TX office. Responsibilities: Policy & Regulatory Include 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 Contracting 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 Community Partnership & Training 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 Team Supervision 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 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 *The salary range for this role is $85,500 to $120,000. #J-18808-Ljbffr Sonida Senior Living