REMOTE WORKFORCE WITH PERIODIC IN PERSON MEETINGS AT CORPORATE OFFICE.

The Senior Healthcare Accountant will perform advanced accounting in the management of the Plan’s accounting and financial systems including, but not limited to, preparing financial and statistical reports and statements.  This position will assure regulatory, contractual, or audit compliance commitments are achieved for all lines of business. 

KEY FUNCTIONS/RESPONSIBILITIES:

• Record monthly revenue as it relates to majority of business lines, including New Hampshire Medicaid, Massachusetts Medicaid, Senior Care Option, and Medicare Advantage.
• Utilize general ledger module to maintain and track receivables relating to above product lines, including receivables and payables associated with contractual obligations such as Risk Share.
• Work collaboratively with many departments to ensure consistency and appropriate levels of communications as it relates to Generally Accepted Accounting Principle results compared to data warehouse information, which includes revenue and other run out adjustments.
• Participate in external audits relating to system and Plan specific fiscal years, calendar yearsand associated reporting.
• Participate in preparation of NAIC and Division of Insurance schedules for quarterly and annual reporting.
• Responsible for provider and vendor contract recording of entries each month, in partnership with other Financial teams.
• Create and maintain financial data warehouse and cube reporting to assist with receivable reconciliations.
• Work with Enrollment to identify, track, and resolve discrepancies related to payments for health plan membership. 
• Run and validate monthly Medicaid reconciliation report; and prepare monthly revenue entries.
• Maintain detailed Medicaid and Medicare Accounts Receivable work paper.
• Maintain Medicaid, Medicare and Commercial rate tables; communicate updates to Business Intelligence team.
• During reconciliations with Medicaid, work with Enrollment Operations and IT reporting staff to identify, track, and resolve discrepancies related to payments for Medicaid membership from the previous periods.
• With Compliance Officer, construct annual Finance Compliance Calendar, which includes reports and dates when internal actions are required at a specified time to comply with Medicare, Medicaid and Department of Insurance regulations.
• Document answers to week-to-week queries from Actuarial Department, Compliance Officer, DOI, Medicare, or Medicaid.
• Participate actively in monthly Senior Care Options (SCO) Compliance work sessions. 
• Collaborate with internal teams (Actuarial, Accounting/Finance, Enrollment, Pharmacy, etc.) to develop Medicare Audit responses and submit to Compliance officer for approval.
• Match accounting entries to Medicare Actuary’s Medicare Part D model for revenue and expense.
• Perform Model Audit Rule and “SOC 1” controls with particular focus on Medicare revenue streams, Behavioral Health and Kick payments.
• Participate in regular meetings with New Hampshire Department of Health and Human Services, Medicare Compliance teams as it relates to administrative issues, regulatory requirements and  discrepancies with health plan payment reconciliations.
• Coordinate with Enrollment to reconcile monthly membership between the health plan’s data and Medicare. Check exact receipt of cash anticipated from Medicare and Medicaid to payment files.
• Prepare monthly Accounts Receivable/Medical benefit cost offsets entries.  Reconcile cash payment applications against receivable balances  Analyze prior period adjustments and their impact on current month to normalize current month.  Reconcile discrepancies.

QUALIFICATIONS:

EDUCATION:

• Bachelor’s degree in Accounting required.
• CPA License preferred.
• Insurance/ healthcare experience preferred.

EXPERIENCE:

• Five or more years progressively responsible accounting experience.
• Medicare accounting experience absolutely required.
• Knowledge of Statutory Accounting Principles desirable.
• Exposure to managed care insurance desirable.

COMPETENCIES, SKILLS, AND ATTRIBUTES_:  _

• Advanced knowledge of Generally Accepted Accounting Principles (GAAP).
• 4-5 years of accounting experience in health insurance industry with focus on compliance.
• Knowledge of accounting and auditing principles and practices under GAAP and statutory accounting.
• High proficiency in Excel and Microsoft Office Systems.
• Detail oriented, focus on accuracy.
• Ability to prioritize and meet tight deadlines.
• Excellent verbal and communication skills.
• Experience in or knowledge of managed care or health care financial systems preferred.
• Willingness and ability to perform day-to-day fiscal activities at all levels.
• Ability to communicate clearly and effectively, work accurately, meet deadlines and provide effective management reporting is required.
• Excellent interpersonal skills required to develop and maintain effective working relationships across all levels within the organization is of the essence of this position.
• Ability to work both independently and as part of team.
• Demonstrated ability to plan, organize and manage modest projects successfully.
• Detail-oriented, excellent proof reading and editing skills.
• Collaborative, service oriented dealing with peers and Boston Medical Center staff.
• Commitment to documenting desk procedures; and training other assignees as back-up.

WORKING CONDITIONS AND PHYSICAL EFFORT:

• Remote workforce with periodic in person meetings at corporate office.
• Ability to work overtime during peak periods.

*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.

Required Skills Required Experience