Job ID 2013-24237 # Positions 1
Search Category Health Care Operations
Type Regular Full-Time (30 hours) Posted Date 9/23/2013
Additional Locations ..
More information about this job:
The VP Finance (Plan) will largely focus and be accountable for identifying and valuing solutions which serve to improve the operating performance of the Plan through strategies and initiatives which contribute to effectively managing operating gain. This includes a focus on topline, capital investments in the local operations, management of local administrative costs, and driving medical expense improvements. This position is responsible for owning, managing, and driving the budgeting, forecasting, and financial analysis functions of the health plan or region to ensure the achievement of membership, premium, medical expense, gross margin, and local SG&A goals on a quarterly and annual basis, plus local analytics and reporting necessary to support business decisions across all functional areas with actionable information. Major activities owned by this position include the annual budget, quarterly forecasts, financial statement analysis and interpretation, ownership of the HCI/CoC process to maximize operating gain, management and tracking of the State P4P incentive programs and process, and participation in the premium rate-setting process. The VP will work collaboratively with health plan and corporate management in all areas of responsibility to ensure the organization is focused on current results vs. budget, current financial performance trends, and the identification and execution of initiatives to properly manage revenue, medical, gross margin, and SG&A to plan.
1. Own topline, medical expense, and local/direct SG&A portions of annual budget process & quarterly forecasts:
a. Drive process with Plan leadership in conjunction with CEO/COO;
b. Conduct/coordinate all analysis required for membership, premium yield, medical expense, quality initiatives, incentive programs, and local/direct admin by product;
c. Provide all required files to Home Office Finance departments within required timeframes.
2. Provide updated topline and medical projections as needed by the Home Office due to material changes in the business environment (new membership, new product, new provider contract, etc.)
3. On a monthly and quarterly basis, provide necessary information to Actuarial for the medical accruals including:
a. Large cases not in claim experience;
b. Major contract changes not in claim experience;
c. Other utilization or unit cost events not in claim experience.
4. Full participation in monthly operational meetings, financial statement meetings, and medical accrual meetings.
5. On a quarterly basis, provide all necessary information for the other known liabilities, including detailed analysis for auditor review, within required timelines of close process.
6. On a monthly basis, analyze, interpret, and communicate financial statement and medical accrual results to plan leadership for the month, quarter-to-date, and year-to-date a. Identify and explain all variances to budget/forecast b. Identify trends & key drivers in revenue and medical and roll them into HCI process for action c. Assess impact on quarterly and full year budget/forecast targets for topline, medical expenses, gross margin, MLR, pre-tax/pre-corporate earnings, and operating gain.
7. Own the HCI program and ensure its success for the health plan in achieving revenue, medical, and gross margin targets on a quarterly and annual basis according to budget/forecast.
8. Conduct and manage all required analysis for the HCI program:
a. Identify, assess, document, and monitor all opportunities to maximize revenue and manage medical expenses to budget/forecast through membership, premium rate, unit cost, utilization, and cost containment initiatives;
b. Ensure 150% of gross margin gap to budget/forecast is explained at all times;
c. Fully utilize process tools and methodologies in accordance with Corporate standards.
9. Fully engage and collaborate with other Plans and Home Office departments to identify, define, and use standard tools and analytical approaches, including use of common data sets. Interaction with Health Care Economics, Finance, Medical Management, Claims, Cost Containment, Provider Service Operations, Program Integrity, and Premium Reconciliation is expected.
10. Participate and contribute to “Best Practice” forums with other Plans and Home Office to share initiative successes, share lessoned learned, identify best practices across the company, and identify new initiatives not currently implemented at the Plan.
11. Monitor monthly cost containment activity, including investigation and resolution of adverse changes in collection activity a. Provide direction to Cost Containment Unit for additional expense savings opportunities not taken.
12. Monitor monthly claims production, including investigation and resolution of adverse changes in production statistics and their impact on medical accrual estimates.
13. Monitor monthly supplemental revenue collections such as Maternity kick payments, Newborn kick payment, and reimbursable drugs, including investigation and resolution of adverse changes in collection activity.
14. Monitor, analyze, and report any variances for local and direct administration expenses.
15. Identify and drive opportunities for savings with Plan leadership on a monthly basis.
16. Work with Actuarial to understand key drivers of the premium development for each product.
17. Identify and monitor the assumptions and issues in the rate methodology that drive financial success including trend, populations covered, benefits covered, unit cost assumptions, risk adjustment, birth rates, newborn enrollment rules, special populations (i.e. AIDS/HIV), utilization assumptions, and program changes.
a. Communicate to key Plan leadership and ensure they understand the drivers of success underneath the premium rates;
b. Monitor performance against quantifiable drivers of premium rates and resolve adverse variances as they arise.
18. Partner with Quality Management Leadership to own and drive any State required P4P incentive programs and HEDIS improvements. Own scorecard development and tracking, sizing of risks and opportunities with achieving premium incentive goals, identify and monitor compliance risks and financial impacts, and provide routine analysis and reporting to QM team to ensure successful initiatives and outcomes:
a. Provide financial and analytical oversight in development of member and provider incentive programs;
b. Provide outcomes reporting and assessment of quality initiatives.
EDUCATION AND EXPERIENCE
- MBA or CPA
Years and Type of Experience Required:
- 12 years Managed Care Finance, Accounting, or Actuarial experience in a leadership role in a health plan and at least 5 years leadership management experience Specific Technical Skills
- Proficient in Microsoft Windows environment including the Office suite of products, proficiency with database programs such as Microsoft Access, advanced skills in Microsoft Excel, advanced analytical skills, and excellent communication skills.
# Direct Reports:
# Indirect Reports:
Budgetary $ Responsibility: Entire Plan budget
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.