Director, Health Plan ControllerSummaCare - 1200 E Market St, Akron, OHFull-Time / 40 Hours / DaysHybridAs the Director Controller in our Finance team, you'll play a key leadership role in working closely with the SummaCare CFO and the rest the leadership team in maintaining the financial strength and integrity of the SummaCare entities. The Controller plays a critical leadership role in accounting, financial reporting, financial planning and analysis, treasury management, and audit oversight for the SummaCare entities. This is a unique opportunity to work within a bigger Finance team that is comprised of a broad array of functional areas, outside of the Controller's direct responsibilities, including operational analytics, financial analytics, underwriting, Medicare Advantage bid development, product pricing, provider contracting, and risk adjustment.
SummaCare is the health plan arm of Summa Health, and is comprised of two Ohio domiciled regulated entities, a TPA, and other related entities. Lines of business include Medicare Advantage, Individual and Family Plans, Small Group ACA, Small Group Transitional, MEWA, Large Group and Self-Funded.
Summa Health and SummaCare are working together to design the integrated healthcare model of the future-come lead with us on this fun and meaningful journey!
Summary:
Responsible for the leadership of overall health plan financial operations, including all elements of financial reporting, accounting, budgeting, forecasting, benchmarking, investments, and TPA accounting. Ensures internal and external financial reporting needs are met in accurate and timely fashion. Ensures financial reporting meets Generally Accepted Accounting Principles (GAAP) and Statutory Accounting Principles (SAP). Work closely with the health plan CFO on financial decisions and presentations for Senior Management, Summa Health System leadership team, the Board of Directors and the Audit Committee.
1. Formal Education Required:
a. Bachelor's Degree
b. CPA license or 4 additional years of experience
2. Experience and Training Required:
a. Ten (10) years' experience to include, management of Accounting department, financial reporting, budgeting, forecasting, benchmarking, auditing, cash management and other fiduciary activities.
b. Five (5) years direct supervision of staff also required.
c. Three (3) years of experience working for a health insurance/heath plan, consulting with, or auditing said companies.
Essential Functions:1. Develops and maintains regular financial reporting procedures, for six companies with annual revenue (premium equivalents) of approximately a half a billion dollars, to ensure timely reporting of financial results to the CFO, Senior Management, Summa Health System leadership team, the Board of Directors, federal/state/local regulatory agencies, and other external users.
2. Oversees the preparation of timely and accurate accounting and financial reporting for 6 companies, conforming to Generally Accepted Accounting Principles (GAAP) and Statutory Accounting Principles (SAP).
3. Develops and maintains an effective system of internal control that ensures compliance, safeguarding of assets, and integrity of financial reporting.
4. Oversees the process of administrative cost allocations, ensuring that costs are appropriately allocated to each of the 6 health plan companies in a manner that is appropriate and auditable.
5. Oversees the preparation, reporting and monitoring of the annual budget, monthly forecasts and the annual administrative cost benchmarking (Sherlock report) for all six companies. Creates proforma statements to analyze the impact of contemplated business changes.
6. Work collaboratively across all functional areas and across all System companies to assure stakeholders understand the health plan's financial position so educated decisions can be made. Be a resource and advisor to management both within SummaCare and within Summa Health System.
7. Develops and maintains relationships with both external auditors and federal/state regulators in ensuring that annual audits and reviews yield successful outcomes. This includes, but is not limited to, the annual financial audit by RSM, CMS bid audits, CMS financial audits, Marketplace ACA audits and the Ohio Department of Insurance audits.
8. Reviews the Accounting team's recommendations and ensures appropriate analysis in completed and appropriate accounting is applied to very material judgements and estimates including, but not limited to:
a. Claims Reserves: Analyze monthly claims payments, claims inventory, Summa Health volumes and other data to make sound decisions on the monthly claims incurred but not reported estimate.
b. Accrued CMS Revenue: Work with all Finance areas to ensure accurate revenue recognition and projections including Medicare mid-year and annual reconciliation, Medicare Part-D reconciliation and ACA Risk adjustments.
c. Value Based Contracts: Drive across the organization to ensure that all VBC are identified and accounted for consistently with the terms of each contract and appropriate assumptions are used for each component. This includes, but is not limited to, significant judgement around appropriate assumptions around applicable claims reserves and accrued revenue.
9. Develops long- and short-term departmental goals, and ensures that assigned function is staffed to meet the current and future needs of the organization. Ensures same are consistent with philosophy and mission of SummaCare, as well as remaining in compliance with regulations, guidelines, and standards.
10. Performs all job functions with integrity. Provides timely internal and external customer service in cooperative, professional, and respectful manner.
3. Other Skills, Competencies and Qualifications:
a. Population Specific Competency: Ability to effectively interact with patients/customers with the understanding of their needs for self-respect and dignity
4. Level of Physical Demands:
a. Light: Exerts up to 20 pounds of force occasionally and/or up to ten pounds of force frequently, and/or a negligible amount of force continuously.
$72.89/hr - $109.34/hr
The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.
Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.
- Basic Life and Accidental Death & Dismemberment (AD&D)
- Supplemental Life and AD&D
- Dependent Life Insurance
- Short-Term and Long-Term Disability
- Accident Insurance, Hospital Indemnity, and Critical Illness
- Retirement Savings Plan
- Flexible Spending Accounts - Healthcare and Dependent Care
- Employee Assistance Program (EAP)
- Identity Theft Protection
- Pet Insurance
- Education Assistance
- Daily Pay
