GENERAL SUMMARY: To assist the Revenue Management and Risk Adjustment department (RMRA) in ensuring the Financial Reporting and Analysis responsibilities for the oversight of the Revenue Management and/or Risk Adjustment programs for all government funded product lines. Under direction of Department Manager:
PRINCIPLE DUTIES AND RESPONSIBILITIES: Assures, reviews and monitors the work of analyst & Reconciles data integrity issues as needed related to:
Coordination of monthly and ad hoc data submissions, monitoring data for accurate tracking and reporting of medical, drug claim data and membership data to CMS RAPS, EDPS and DDPS and Edge Server. Produce, distribute, monthly, quarterly, and annual key performance indicators (KPI's) and error/rejection detail for all report submissions and external vendor support system data correction.
Premium reconciliation reports for monthly financial close; file payment issues with CMS and monitor response; monitor MMR accruals; estimate risk adjustment premium impact for final reconciliation with CMS; allocation of premium to at-risk provider networks
Maintenance of the following queries and analysis: Reconciliation reports for Risk Adjustment, Reinsurance, Risk Corridors, APTC, Cost Sharing, and Part D program receivables and payables for monthly accounting needs. Monitor accruals for final reconciliation with CMS and cost sharing.
Develop and enhance reporting capabilities for financial and operational performance.
Annual financial reporting activities including CMS bid filings, HCR Premium Development, RFP on financial Risk Adjustment projects, Employer Group Rate Renewals, financial audits, CMS Attestations, premium and member revenue budgets, Medical Loss Ratio reporting.
Produce reports to provide M&B discrepancies in the premium payments from CMS. Team with Membership & Billing staff to identify and resolve enrollment, claims, and provider and premium discrepancies. Develop detail to support reporting discrepancies to CMS for discrepancies outside of M&B's influence.
Completes the following:
Monitor CMS material and calls for required compliance and system or process changes. Work with management on design and implementation of the changes.
Development and maintenance of departmental policies and procedures for audit purposes and support department in adhering to HAP Compliance department requirements. Complete routine monitoring of departmental procedures and documentation to demonstrate internal (MAR) and external (CMS) audit readiness.
Coordinate and assigns tasks related to testing IT projects and new system related initiatives and CMS software releases. Analyze department reports to identify data integrity issues, system and programming problems, and work with management to develop and implement improvement solutions.
Assist department in performing routine assignments, ad-hoc projects and meeting established deadlines. Engage assistance of departmental support analysts in completion of required responsibilities where appropriate.
Perform other related duties as assigned.
Additional Duties and Responsibilities: Leads liaison work between RMRA department and other departments and divisions within HAP and HFHS
Lead in special project assignments for new initiatives related to revenue management and risk adjustment
Fulfills Compliance Lead role for Department ensuring Compliance Department requirements are met
Use appropriate tools to estimate accruals for Risk Adjustment, Part D payables/receivables (LICS, Reinsurance, Coverage Gap, Plan to Plan) and Cost Sharing for final reconciliation with CMS
Act as Business / Technical lead for special projects defining business and testing requirements
Collaborates with Manager in design of financial reports and dashboard metrics reporting
Lead new query development, new report development, & analyzing of membership, financial, and statistical data
Oversight of all data models/tools used for financial reporting for receipt and load of current data and validation for accuracy and completeness
Monitor CMS material and calls for required compliance and system or process changes. Work with management on design and implementation of the changes.
Develop detail to support reporting payment issues to CMS. Monitor CMS response status to filed issues for prompt resolution and advise Management
Completes training, oversight and monitoring of team staff
Oversight and monitoring of team projects
Develops processes that improve reporting, audit documentation, operations, performance and compliance
Responsible for the development and maintenance of departmental procedures
Responsible for assuring department contract and regulatory compliance for all tasks assigned
EDUCATION/EXPERIENCE REQUIRED:
Bachelor's degree in Accounting, Finance, Business Administration or a related field (must include financial or accounting related course work) required.
Completion of Advanced Access, Excel, GQL, Cognos, or SQL training preferred.
Master's degree preferred (Finance, Business Administration, etc.)
Two (2) years of Accounting/Finance business related experience required.
Two (2) years managing projects and initiatives designed to improve business operations required.
Three to five (3-5) years of experience developing, analyzing, interpreting & trending data preferred.
Experience with Medicare Advantage, Medicare Part D, Medicaid or Qualified Health Plans or Affordable Care Act preferred.
Experience in health care finance preferred.
Knowledge of HAP's Core system operations and functionality preferred.
Knowledge of business principles and functions required.
Proficient knowledge of Windows - Excel and/or Access required.
Proficient at using various data sources to develop relevant reporting tools, and to use those tools to enhance processes and procedures required.
Knowledge of accounting and financial reporting principles and business functions required.
Ability to research, analyze, interpret, trend, and implement process improvement initiatives required.
Ability to collect and prepare data for written/oral presentation - report creation and generation required.
The ability to work effectively with all levels within the organization required.
Excellent written and verbal communication skills required.
Well defined problem solving and decision making skills required.
Knowledge of Facets or other Health Insurance Claims/Membership systems preferred.
Knowledge of Medicare and/or Medicare Advantage processes preferred.
Visual Basic preferred.
Experience with Cognos, SQL Developer, and GQL reporting tools preferred.
Additional Preferred Experience:
ve (5) years of Accounting / Finance experience in Health Care or Managed Care Organization
Five (5) years of experience developing, analyzing, interpreting & trending data
Five (5) years of experience with Medicare Advantage, Medicare Part D, Medicaid or Qualified Health Plans * Proficient knowledge of MS Office products Advanced Access, Excel, Word, Power Point
Experience in health care finance, claims processing, and Medicare program payment methods
Affordable Care Act (ACA) experience or knowledge
Project management experience
Additional Skills and Abilities:
Ability to collect and prepare pertinent data for report creation and generation
Highly motivated self-starter with strong work ethic and professional attitude
Demonstrated leadership and presentation skills
Calculative and analytically minded from a systems perspective
Attention to detail and thoroughness; known ability to include controls in work product
Overview Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health
care systems, is a national leader in clinical care, research and education. The system includes
the 1,200-member Henry Ford Medical Group, five hospitals, Health Alliance Plan (a health
insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory
network and many other health-related entities throughout southeast Michigan, providing a
full continuum of care. In 2015, Henry Ford provided $299 million in uncompensated care.
The health system also is a major economic driver in Michigan and employs more than 24,600
employees. Henry Ford is a 2011Malcolm Baldrige National Quality Award recipient. The
health system is led by President and CEO Wright Lassiter III. To learn more, visit .
Benefits Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. My Choice Rewards is a program as diverse as the people it serves. There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.
