Directs, plans and develops policies and processes for data integrity, regulatory reporting and medical cost activities for VNS Health Plans finance department. Analyzes needs of VNS Health Plans for financial requests and ensures data integrity for reporting requirements. Assesses, prioritizes and leads special projects/requests in terms of project scope, objectives, workflow, impact and resources. Directs, monitors and oversees production of defined reports. Works under general direction.

Oversees the development, coordination, and preparation of NYS Department of Health (DOH) regulatory financial reporting  including MMCORs, VBPTR and MLR for all lines of business.  Ensures the integrity and availability of critical financial and actuarial data necessary to address needs of the finance department.  Ensures data is usable and easily translatable in a transparent and timely manner.

Acts as the liaison for special financial reporting projects involving other departments across the organization.  Assesses, prioritizes and leads projects/requests in terms of project scope, objectives, workflow, impact and resources.  Involves/forwards to appropriate parties as necessary.  Tracks and monitors work plans including objectives, tasks and time frames to ensure deliverables are completed.

Analyzes data for financial requests, including utilization and medical costs analyses, operational reporting, and regulatory reporting requirements.

Directs/monitors/oversees production and direction of defined reports to ensure accuracy and efficacy of data capture and reporting compliance.  

Advises and provides financial analyses to senior leadership when planning new programs and estimating opportunities and risks.  Ensures consistent financial evaluation methodologies. Creates methodologies to track achievement to business case once a new program is initiated.

Builds, implements, monitors and enhances analytic process(es) necessary for timely and accurate regulatory cost reporting across all products.  Identifies necessary enhancements/modifications to source data systems and collaborates with owners/stakeholders of such systems to ensure effective implementation.

Develops trend analytics including member cohorts classification, Per Member Per Month metrics, utilization, cost per service and mix of services/providers.  Develops ROI/savings estimation models for agency’s utilization management initiatives.

Builds, implements, monitors and enhances monthly analytic data flow process(es) and collaborates with IT to ensure that departmental data needs are provided through systems, and that formats and definitions are consistent between functional areas. 

Investigates and analyzes root causes, patterns, or trends that can impact the organization’s financial liability. Participates in the identification and implementation of corrective action where appropriate.  Develops approaches to improve financial analysis quality and consistency.  Performs quality assurance as needed.

Keeps abreast of NYS and Federal policies for managed care health plans; informs leadership with analytic insights regarding potential impact on VNS Health businesses.

Identifies opportunities to improve operational efficiencies for work process review; leads implementation of changes, as appropriate; and quantifies operational efficiencies realized from process redesigns. 

Analyzes new reimbursement methodologies for new and emerging third party payment mechanisms.

Works with Government Affairs, regulators and third parties to identify potential impact of proposed rulemaking on cost, regulatory and financial data reporting.

Provides oversight and guidance on policy/regulatory questions, including but not limited to, consultations with government representatives from CMS and/or NYSDOH..

Performs all duties inherent in a managerial role.  Ensures effective staff training, evaluates staff performance, provides input for the development of the department budget, and hires, promotes, and terminates staff and recommends salary actions as appropriate. 

Participates in special projects and performs other duties, as required.

Education:

Bachelor’s degree in Accounting, Finance, Public Health, Healthcare Informatics, Health Administration or other relevant discipline required. 

Master’s Degree in Accounting, Finance, or Business Administration is preferred. 

Experience:

Minimum eight years of progressively responsible finance experience, with a minimum of five years of experience in regulatory reporting including MMCORs, MLR, VBPTR, required.    

Experience working directly with and presenting to Executive management required.   

Experience with analytic data products required.

Knowledge of health care data required. 

Knowledge of health plan financial and regulatory reporting standards required.

Experience with the following applications preferred: Python, R, SAS, Microstrategy, Snowflake, PostgreSQL.