The Manager of Regulatory Reporting is a key member of the Finance management team. Under supervision of the Director of Financial Planning and Medical Economics, the Manager oversees all aspects of financial, membership and provider network reporting that is required under our various state contracts. This type of financial reporting is generally related to reporting requirements tied to specific contract periods for each line of business which present results on an incurred basis with a specific amount of runout for common income statement metrics like membership, revenue, medical expenses and administrative expenses. This financial reporting should not be confused with typical audited GAAP / Statutory accounting reports maintained by our accounting department, although it is necessary for the Manager to understand the sources of difference between the two types of financial reporting.
KEY FUNCTIONS/RESPONSIBILITIES:
Regulatory Reporting responsibilities include, but are not limited to, the following:
- Oversee preparation and submission of regulatory financial and membership reports related to contract requirements for all lines of business.
- Prepare and present regular financial reports comparing actual results versus budget for our various MassHealth ACO partners, working with other leaders across the company to explain key drivers of the variances. Reports include both historical and projected performance.
- Work with the Information Technology (IT) team leaders to identify and explain gaps between encounter data and reported financials.
- Work with multiple Data Warehouse environments / data sources to pull data for various reports, understanding and documenting known differences between data sources.
- Work with financial forecasting team to incorporate projections into various regulatory and internal reports.
- Work with financial forecasting team to reconcile regulatory reports to statistical financial models to ensure regulatory reports are within an acceptable threshold.
- Work with financial accounting team to understand differences between statistical results and GAAP / Statutory results for each product lines, especially any large adjustments related to prior periods and / or Premium Deficiency Reserves (PDRs) for future periods.
- Validate reports generated by CHIA and other state agencies to ensure consistency with internal reporting.
- Support the provider analytics team in modeling potential impacts of adding or removing providers from the network in order to meet mandated network access requirements.
- Work with legal department to request publicly available financial reports from various state agencies.
- Work with financial planning team to prepare and present competitive analysis summaries which show how our reported results compare to publicly available reports submitted by our competitors.
- Work with partners across the company to develop and submit any new reports required by various regulatory entities.
- Adapt existing reports to accommodate any program or population changes related to regulatory reports.
Other Functions/Responsibilities:
- Directs a team of health care analysts using SAS and other query languages for data mining, reporting, evaluation and outcomes measurement. Lead analysts in the design, development and implementation of evaluation methods and tools to measure the effectiveness of both internally developed medical management initiatives or externally purchased vendor programs.
- Responsible for staff hiring, work allocation and scheduling, training and professional development, performance management and related supervisory activities.
QUALIFICATIONS:
Education:
- Bachelor’s Degree in Mathematics, Actuarial Science, Finance, Economics or related field required.
- Master’s Degree, Fellow of the Society of Actuaries (FSA) or Associate of the Society of Actuaries (ASA), preferred.
- Proficiency with SAS or comparative tool, preferred.
Experience:
- A minimum of five years of progressively responsible experience in health care analytics, actuarial analysis, trend analysis, regulatory reporting or similar analysis. Commensurate educational experience in related field will be considered.
- Working knowledge of standard income statement metrics and terminology.
COMPETENCIES, SKILLS, AND ATTRIBUTES_:_
- Expert analyst with an ability to translate findings into actionable opportunities.
- Ability to use well developed interpersonal skills to lead and direct the efforts of others, both internally and externally required.
- Working knowledge of MS tools, including MS Office products, MS Access, MS Project.
- Must be able to conceptualize and envision the impact of change, and propose new ways to do business.
- Ability to meet deadlines, multi-task, problem solve and use appropriate technology to analyze business problems. Project management skills a plus.
- Strong communications skills, both verbal and written, are required.
- Strong understanding of health care data and analytical methodologies.
- Strong team player.
- Effective collaborative and proven process improvement skills.
*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