Team Leader II / Provider Financial Analysis HCV

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Southfield, MI

Blue Cross Blue Shield of Michigan

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keywords: management,maintain,analysis,risk management,consulting,leadership,accounting,reporting,experience,leadership,degree


Competitive Compensation and Benefits Package

Overview: Responsible for the supervision of the day to day operations of the accounting staff to ensure appropriate and accurate accounting for statewide Primary Care Physician (PCP) capitation, Primary Care Group (PCG) risk settlements, Provider Recognition Program (PRP) incentives, BCBSM PHA Hospital settlements, and other provider/vendor medical and administrative expenses for all BCN product lines. Maintain collaborative working relationships with Provider Affairs, Financial Reporting and the Medical Division to ensure complete data for the budget, forecast, monthly and year-end close processes.&nbsp;
Responsibilities: <ul> <li>Leads, implements, plans, and monitors all unit activities, including workflow and accountable for decisions made by staff regarding accounting and financial analysis.</li> <li>Use independent judgment to exercise authority on behalf of the company to recommend actions such as developing and/or assisting in budget/forecast/year-end close preparation, staff training, and development, corporate policies and procedures, etc.</li> <li>Oversees the reporting of PCG settlement analyses and provides a detailed review to ensure that the data is accurate as it is used in budgeting, forecasting, and year-end accruals to determine BCN&rsquo;s liability.&nbsp;&nbsp;Includes reviewing the multi-dimensional PCG contracts to ensure we have accurately assessed the PCG settlement liability for all physician risk arrangements for all product lines as well as coordinating meetings with Provider Affairs to gain their feedback.</li> <li>Oversees and reviews the monthly/quarterly administrative and medical expense payments to PCGs and statewide providers/vendors, including lab and DME.&nbsp;&nbsp;Includes a review of the provider/vendor contracts to ensure we are in compliance with the contract.</li> <li>Responsible for the review and approval of all journal entries and general ledger account reconciliations for the medical and administrative expense accounts related to PCP capitation, PCG risk settlements, physician recognition program, BCBSM PHA Hospital settlements, and all the statewide providers/vendors.&nbsp;</li> <li>Responsible for the development, review, and approval by the Director and the VP/Treasurer of Finance of all budget, forecast and year-end accrual of all medical and administrative expenses related to PCP capitation, provider incentives, BCBSM PHA Hospital settlements, and all statewide providers/vendors and PCGs.&nbsp;&nbsp;Includes preparing supporting schedules and meeting with auditors for a year-end review of financial statement general ledger accounts.</li> <li style="font-weight: 400;">Responsible to provide the projected expenses to be included in the annual CMS Bid from the department&rsquo;s area of responsibility.</li> <li style="font-weight: 400;">Oversees the Express Scripts pharmacy vendor monthly accrual.&nbsp;&nbsp;Review analyses by staff to ensure accurate accruals of pharmacy expense.&nbsp;&nbsp;Notify leadership of any significant variation.&nbsp;&nbsp;&nbsp;&nbsp;</li> <li style="font-weight: 400;">Create and follow strong internal controls in analyses of actual to budget variance and explain/resolve the variance.&nbsp;</li> <li style="font-weight: 400;">Represent department in various committees and work groups as required.&nbsp;</li> </ul>
Requirements: <ul type="1"> <li> <p><span style="font-family: arial, sans-serif;"><span style="font-size: small;">Bachelor's Degree with a major in Accounting or Finance required.&nbsp;&nbsp;&nbsp;</span></span></p> </li> <li> <p><span style="font-family: arial, sans-serif; font-size: small;">Five (5) years general accounting, financial reporting and budgeting experience required.&nbsp;&nbsp;Three (3) years of health care industry experience required, managed care related experience preferred.</span></p> </li> <li> <p><span style="font-family: arial, sans-serif; font-size: small;">Two (2) years demonstrated experience utilizing spreadsheet, word processing and database management software required.</span></p> </li> <li> <p><span style="font-family: arial, sans-serif;"><span style="font-size: small;">One (1) year of leading projects, lead role required.</span></span></p> </li> </ul>