Manages the financial activities and accounting functions related to the health plan. Prepares financialreporting and analysis for purposes of accurate financial statement reporting as well as executive decision making.
PRINCIPAL DUTIES & RESPONSIBILITIES
- Responsible for overall financial management, budgeting and reporting of health plan related financial and general ledger activity.
- Responsible for development and retention of health plan accounting employees, including supervision and review of daily activities as well as long-term goal setting and department morale.
- Oversees preparation of internal medical loss ratio reporting by line of business, county, membership segment, etc. Responsible for all inputs necessary to develop MLR. Professionally presents related schedules to executive management.
- Oversees timely preparation of the monthly IBNR calculation for all lines of business. Professionally presents IBNR calculation and related schedules to executive management for discussion.
- Oversees premium accounting and reconciliation process, including premiums, membership, all related capitation, management fees, ACA fees, premium taxes, etc.
- Oversees premium reconciliation process for all groups
- Oversees calculation of Medicare Advantage HCC risk adjustment revenue accruals; works with Risk Adjustment department to project risk scores and adjustment payments.
- Oversees pharmacy billing and rebate reconciliation and reporting. Ensures all variances are researched and resolved or explained.
- Oversees review, reconciliation and analysis of monthly and other periodic Medicare Advantage reporting received from CMS
- Oversees tracking, reconciliation, and settlement of of Medicare Advantage Part D Plan to Plan (P2P) and coverage gap discount (CGD) payments.
- Oversees preparation of capitation and shared savings analyses for contracted provider groups.
- Oversees preparation of monthly Medicare Advantage Part D reporting and reconciliation, including calculation of Low Income Cost Sharing, CMS Reinsurance, coverage gap discount, and Rx risk corridor.
- Oversees audit function of Enrollment and Eligibility for purposes of accurate membership reporting, premium billing, commissions and otherfinance/accounting functions.
- Monitors HPMS memos and REGTAP notices to determine impact on the Finance Department and initiates action when necessary
- Works with accounting staff and Controller to ensure an accurate and timely period-end close.
- Assists with preparation for financial examinations performed by the Oklahoma Insurance Department
- Assists with health plan related audit requests during the annual financial statement audit
- Responds to inquiries from CFO, Controller, and others within the Company regarding financial matters, special reporting requests, projects, etc.
- Collaborates with others to support overall department goals and objectives.
- Other duties as assigned
- Bachelor's degree in accounting or business administration and a minimum of four years of accounting experience
- Certified Public Accountantdesignation preferred
- Public accounting experiencepreferred
- Management experiencepreferred
KNOWLEDGE, SKILLS & ABILITIES
- Strong spreadsheet skills, as well as general computer and software application operation skills.
- Proficiency in mathematical skills.
- Strong organizational, prioritization, and time management skills.
- Able to research, understand, and apply published guidance to achieve department goals and objectives
- Able to multi-task, work under pressure and meet requireddeadlines.
- Strong verbal, listening, and written communication skills.
- Good interpersonal skills and ability to work well with others.
- Demonstrates dependability through attendance and adherence to timelines and schedules
- Displays follow-through on projects and deliverables.
- Possesses attention to detail.
- Able to maintain strict confidentiality guidelines.
- Demonstrates sound judgement and high ethical standards.
- Able to organize and supervise work of others.
- This job operates in a professional office environment, routinely using standard office equipment, such as computers, phones, filing cabinets and a fax/copy/scan machine.
- May be subjected to fast-paced decision making, crisis situations.
- Periodic weekend or evening work is expected.
This is sedentary work that requires the following physical activities:
- Sitting for long periods of time, walking, finger dexterity, feeling, repetitive motions, talking, hearing, and visual acuity.
- Occasional lifting (up to 10 pounds of computer equipment or paper supplies).
Supervises managed care accountant(s) and analyst(s). Expected to work collaboratively with other departments.