This position is responsible for managing financial reconciliations and forecasting for the Medicare Part D EGWP product line. The Financial Analyst (FA) reconciles all financial payments from CMS, third party organizations, and employer groups. The FA ensures compliance with Medicare Part D regulations as it relates to receipts and payments of subsidies, rebates, and/or premiums (if applicable). The FA ensures that the appropriate processes, procedures, and software are updated and maintained to meet these requirements. The FA acts as the liaison with Client Services, Government Program Operations, and Finance as it relates to subsidy payments, schedules, reconciliations, and forecasting.
- Develops and maintains deep subject matter expertise related to Medicare Part D Payment processing and related financial functions.
- Reconciles monthly, quarterly, and annual CMS reimbursements to the employer group and manages the group level reporting and payments.
- Manages monthly Plan to Plan (P2P) payment processes.
- Monitors client performance related to CMS subsidies. Addresses outliers by determining root cause and seeing investigation through to completion.
- Reconciles monthly Low Income Premium Subsidy (LIPS) payments and CMS Late Enrollment Penalty (LEP) offsets to the employer group or retiree.
- Manages the spreadsheets that document capitation payment reserves and reconciles to subsequent payments to the employer groups.
- Reconciles CGDP (manufacturer) payments including CMS invoice to manufacturer, manufacturer payments, reporting to CMS, and managing the dispute processes.
- Forecasts EGWP client subsidies as requested. Facilitates prospective client forecasts in conjunction with actuarial services partner.
- Performs ad hoc analyses in response to client requests for CMS subsidy impacts to client benefit designs and performance.
- Conducts annual reconciliations of all subsidies and payments. Facilitates annual reopening process.
- Oversees cash receipts and distributions.
- Maintains all policies and procedures that support the financial management and reconciliation processes.
- Administers CMS overpayment processes.
- Provides Medicare Part D SME support to Implementation Team for annual and new client implementations.
- Develops, modifies, and improves business processes and policies.
- Employs a "hands on" approach to issue identification and resolution. Utilizes various tools to proactively monitor data quality.
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
A minimum of a Bachelors Degree in Finance or Accounting.
Minimum of 5 years' experience of financial reconciliation and analysis in the healthcare industry. Medicare Part D financial management experience preferred. Expertise with financial management tools, business analysis, reconciliations and reporting, with a "track record" of tangible success, including team collaboration/relationship-building or management in a health care or related environment is essential. Experience and expertise in government program compliance highly desired.
A minimum of a Bachelor's Degree in Finance or Accounting.
Minimum of 3 years' experience in financial reconciliation and analysis in the healthcare industry. Expertise with financial management tools, business analysis, reconciliations and reporting, with a "track record" of tangible success, including team collaboration/relationship-building or management in a health care or related environment is essential. Experience and expertise in government program compliance highly desired.