This is an exciting brand new role on our collaborative finance team supporting our new ACO partnerships. It's a unique opportunity for a strong seasoned Accounting expert with Medicaid and Managed Care expertise to not only help create a new position but also make a great impact on the financial side of a new business direction for Fallon. We will also leverage your strong financial analytics and communication skills as we forge new relationships.
About Fallon Health:
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is the only health plan in Massachusetts to have been awarded “Excellent” Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.
Brief summary of purpose:
This position bridges accounting and analytics. Individual will be responsible for independently extracting data from EDW and QNXT and utilizing data to record accounting entries and for financial reporting and analysis.
Major areas of responsibility and accountability:
• Manage WD schedules and monthly close schedule to complete membership, medical and other general ledger cycles.
• Participate & assist in the monthly close meetings if required, to ensure compliance at each stage of the close cycle.
• Analyze monthly results in detail and describe key drivers of variances to enable management to address issues more timely.• Enhance data quality of results by identifying and reporting out of period & non-recurring items.
• Analyze financial results for data integrity – including account reconciliations. Interpret results and develop action plans to correct defects. Identify and communicate defects and errors immediately.
• Partner with manager to communicate with Underwriting, Actuarial, Medical Economics, NDM and other functional areas to collaboratively improve the quality of financial results.
• Create ad hoc reports and analysis as necessary to interpret financial results.
• Monthly financial risk reports for current year and prior year as applicable.
• Annual and Quarterly provider settlement reporting.
• Prepare monthly provider payments.
• Actively work with NDM and Medical Economics to track changes to various provider contractual arrangements and to encourage timeliness & accuracy.
• Represent Accounting in meetings with RMG.
Monthly claim files submissions & reconciliations
• Additional requests and analysis as needed/requested
• Identify process improvements
• Prepare 4B and 5C reports and other requirements from Masshealth/Connector.
• Maintain data to include in various governmental information requests.
• Actively participate and represent Accounting in projects such as EDW redesign,
• FTC, and others as opportunity arises.
• Take ownership of Masshealth programs financial results 15%
• Review, analyze, report and understand key drivers of monthly results.
• Partner with managers and Masshealth program manager to drive improvements & improve financial performance.
• Assist managers in identifying recommendations for savings and assist with forecasting and budgeting.
• Actively contribute to build a high performance culture & positive work environment by demonstrating FCHP values 10%
• Take personal accountability for contribution to team & FCHP results.
• Actively participate & support community events sponsored by FCHP.
• Demonstrate clear professional standards
• Identify training opportunities
Resources (systems, etc.) used in performing role: