Managing Consultant State Payer-Medicaid (Guidehouse)

Clipped from:



  • Job Family

Strategy & Transformation Consulting

Travel Required

Up to 25%

Clearance Required


What You Will Do

Work with the Guidehouse finance and federal reporting teams to review the process flow of completing the quarterly CMS Medicaid/CHIP expenditure reporting forms (CMS-64, CMS-21, CMS-37, CMS-21b) and provide recommendations to make the process more efficient. Provide quality reviews and make improvements to workpapers used to prepare expenditure reporting form submissions. Manage projects and conduct training for Medicaid agency staff to address questions raised and corrections needed to the Medicaid agencies processes. Provide technical advisory for reviews of the expenditure reporting forms performed by CMS, OIG and state auditors. Reconcile expenditure reporting forms to state accounting and claim records.

Job Description/Responsibilities: (bullet format)

  • Assess weakness and provide recommendations on reporting of expenditures, audit adjustments, recoveries, overpayments on the CMS-64, CMS-21, CMS-37, and CMS-21b.
  • Support and audit each step in accumulating, confirming, adjusting, and allocating data as the CMS-64 and CMS-21 reports are completed.
  • Develop reconciliation processes to map expenditures and revenue from the state accounting and claim systems to entries made into the Medicaid and Children’s Health Insurance Program Budget and Expenditure System (MBES).
  • Review workbooks used to support the CMS-64 and CMS-21. Ensure workpapers prepared by Medicaid agency staff have been compared to entries made into MBES. Ensure that any noted variances noted are resolved and that all entries are properly reported prior to certification of the CMS-64 and CMS-21.
  • Prior to the end of the federal fiscal year, prepare the following reconciliations of CMS-64 and CMS-21:
  • Reconcile Federal draws from the U.S. Treasury Payment Management System (PMS) to the Federal Share reported on the CMS-64 and CMS-21.
  • Reconcile Non-Federal share to the total State General Revenue and other revenue sources maintained in a state agencies fund accounting system.
  • Prepare work plans with tasks and target dates for developing protocols, procedures and supporting work templates for the federal reporting forms.
  • Provide status updates to Medicaid agency staff on the progress made in completing work plan tasks.
  • Develop and deliver technical training to Medicaid agency staff on CMS-64, CMS-21, CMS-37, and CMS-21B requirements and processes.
  • Provide technical advisory on reviews and audits of the CMS-64, CMS-21, CMS-37, and CMS-21B performed by external reviewers.


  • BA/BS degree in Health Policy, Economics, Finance, Data Science or other Healthcare/Science/Finance related disciplines OR 10yrs. similar relevant experience, Master’s degree preferred
  • 7+ years of experience working with Medicaid/Medicare or other health care claims data.
  • 5+ years of previous work experience in the health care industry or with a consulting firm to include the following:
  • A complete understanding of the flow information through the forms reported on CMS-64, CMS-21, CMS-37, and CMS-21B reports.
  • Knowledge of all code of federal regulations (CFR’s), state Medicaid manual references, state Medicaid director’s letters, departmental appeals board (DAB) decisions, Office of Management and Budget (OMB) circulars and title XIX/title XXI of the social security act citations applicable to Medicaid and CHIP expenditure federal reporting.
  • Familiarity with Medicaid State Plan Amendments and Public Assistance Cost Allocation Plans.
  • Understanding of basic Medicaid reimbursement methodologies including per diems, Diagnosis Related Group (DRG), Ambulatory Payment Classifications (APC’s), Resource-based relative value scale (RBRVS), Resource Utilization Groups (RUG) and Medicare cost reporting principles.
  • Ability to work overtime


  • 7+years of experience working on hospital-based financing for Medicaid payments (IGT, CPE, CMS-64, DSH assessments, etc.)
  • 5+ years of experience working in a variety of State Medicaid Programs (Rate Setting, CMS 64 other payment initiatives)
  • 5+ years of experience preparing deliverables for healthcare payment and pricing projects, payment incentive models, hospital payment adequacy analyses, federal compliance for Medicaid programs, and federal revenue enhancement programs
  • 5+ years of experience using the CMS-2552-10, Medicare acuity, and Medicaid quality scores in assessing hospital performance and hospital reimbursement through Medicaid
  • Knowledge and experience with the application of methods for risk adjustment, reserving, pricing, and forecasting for health insurance
  • Ability to engage in relationship initiation and cultivation with state Medicaid leaders and/or hospital industry leaders.
  • Proficient in Microsoft Office Suite
  • Superior written and oral communication skills

The annual salary range for this position is $95,100.00-$190,200.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

  • Medical, Rx, Dental & Vision Insurance
  • Personal and Family Sick Time & Company Paid Holidays
  • Position may be eligible for a discretionary variable incentive bonus
  • Parental Leave and Adoption Assistance
  • 401(k) Retirement Plan
  • Basic Life & Supplemental Life
  • Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
  • Short-Term & Long-Term Disability
  • Student Loan PayDown
  • Tuition Reimbursement, Personal Development & Learning Opportunities
  • Skills Development & Certifications
  • Employee Referral Program
  • Corporate Sponsored Events & Community Outreach
  • Emergency Back-Up Childcare Program
  • Mobility Stipend

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at ~~~ or via email at ~~~ . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.