Company Overview Commonwealth Care Alliance is a rapidly growing nonprofit organization providing integrated health care and social support services to people with complex medical needs. Our patients are seniors and persons with disabilities covered under Medicaid or both Medicaid and Medicare. Our innovative care model is nationally recognized for its effectiveness in improving health outcomes for these vulnerable populations.
Our unique care model is empowering for our employees as well as our members. Whether you are a clinical or administrative professional, all of us at Commonwealth Care Alliance receive the satisfaction of knowing our work truly makes a difference. We enjoy a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package.Position Overview Position Summary
This position is responsible for the Financial Reporting focus of the Actuarial Services department. The primary responsibilities of this role are to calculated monthly financial accruals according to actuarial standards of practice. Works with senior management, department heads and other staff on a variety of business support functions to evaluate and monitor Medicare operational activity and financial results. Key Responsibilities
Knowledge, Skills & Abilities
- Provides leadership to staff by planning and coordinating Medicare finance department activities, prioritizing and managing staff workloads, monitoring quality and performance, and providing direct and indirect training.
- Direct responsibility for development and submission of MA-PD bid working with external consultants and other departments, ensuring compliance with filing regulations.
- Overall responsibility for quantitative aspects of risk adjustment revenue opportunity. Conduct financial analysis to track and monitor risk adjustment activity, health care cost initiatives, forecast revenue/cost impacts. Identify revenue optimization opportunities.
- Analyzes factors that affect revenue and develops revenue projections and variance scenarios. Provides annual revenue forecasts and reconciles variances to budget on a monthly basis.
- Direct responsibility for CMS reporting and compliance requirements.
- Ensures timely and accurate performance of routine and ad-hoc analyses for the purpose of assessing and monitoring Medicare line of business performance, including profit and loss. Collaborates with other department heads and senior management for creation, production and delivery of routine and ad-hoc analysis requests such as contract analysis.
- Directs and supervises routine and ad-hoc analyses performed by analysts, ensuring relevance, timeliness and accuracy of analyses performed. Independently identifies strategic areas of opportunity and initiates sufficient analysis to develop recommendations for action as well as the development, production and analysis of tools to monitor results of strategic initiatives.
- Calculate monthly claims reserves.
- Calculate of monthly accruals related to Part D benefit.
- Strong knowledge of care management and healthcare industry practices.
- Strong actuarial, analytical and problem-solving skills.
- Ability to work under pressure and tight deadlines.
- Strong interpersonal and communication (verbal & written) skills.
- Ability to communicate business and technical information to people of various backgrounds.
- Distinguishes true sense of urgency.
- Ability to communicate directly and build trust with senior leaders essential.
- Initiative, work ethic, ambition, and an appetite for challenging and often unstructured assignments.
- Ability to be flexible, accommodating shifting priorities and demands, and reacting quickly to developing issues.
- Proactive and collaborative
ALL APPLICANTS SHOULD SUBMIT A COVER LETTER WITH APPLICATION. Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws