Healthcare Financial Analyst

Duties: This individual will assist the Department of Health’s Office of Health Insurance Programs (OHIP)/Division of Health Plan Contracting and Oversight (DHPCO) in development, analysis and oversight associated with the Medicaid Managed Care Operating Cost Reports for Medicaid and Managed Long Term Care (MLTC) plans, Medical Loss Ratio Reporting and Oversight as well as overall plan solvency.

Specific duties include:

• Responsible for the daily activities related to ensuring Managed Care Organizations (MCOs) in New York State are compliant with State and Federal laws, regulations and policy related to health plan fiscal oversight.
• Assist in the development of quarterly financial reports to collect financial information from the Medicaid Managed Care Organizations (MCOs) in NY inclusive of Medical Loss Ratio reporting and oversight
• Review and oversee timely filing and accuracy of all MCOs financial reporting.
• Conduct reviews of MCOs financial reporting and operating status, including compliance with Public Health Law, regulations, and policies as well as the federal regulations
• Communicate findings and collaborate with MCOs to improve accuracy of financial reporting
• Review and Evaluate plan Solvency.
• Review and evaluate MCO expansions, mergers, and acquisitions for MLTC and Mainstream plans.
• Review and evaluate MCO provider and management contracts for compliance with the financial standards and requirements in PHL.
• Review provider risk contracts (including VBP), Management Service Agreements (MSAs), intercompany agreements and Care Management Administrative Services (CMAS) agreements for the assigned MCOs as to their compliance with financial rules and polices.
• Assist in automating and standardizing financial reports for analysis of fiscal status of the MCO.
• Develop ad-hoc financial reports extracting data, as necessary.
• Will perform research and comparison of applicable State and Federal rules and study best practices in relation to monitoring of plan financial solvency, as well as be responsible for evaluation of MCO Service Area Expansions, addition of new lines of business and mergers and acquisition applications.

Additional Requirements and Day-to-Day Tasks of Position

• Strong Excel and data analytics skills. 

• Strong communication skills (written and oral).

• Ability to present data to parties with varying backgrounds.

• Ability to work independently.

Basic Qualifications:

• Bachelor’s degree in business, finance, accounting, or related field. 

• Two (2) years of work history in finance or healthcare. 

*Employees must follow established work schedules. The usual work schedule is 37.5 hours per week, Monday through Friday. Normal work hours are 8:30 a.m. to 4:30 p.m. unless otherwise specified by the supervisor, this includes a half hour unpaid lunch break. Total work hours must equal 37.5 hours per week.

Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides the following reasonable range of compensation for this role: $68k-86K. In addition, SSO provides a range of benefits for this role.

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.