lthc · Rochester ·
Analyzes healthcare regulatory compliance, calculates surcharges, and prepares filings for New York State HCRA and ACA requirements, using financial and enrollment data.
HCSC · Work From Home (HB)
The ODP Corporation · Boca Raton, FL, United States
HCSC · Work From Home (HB)
hcsc · Work From Home (HB)
fib · Denver, CO
Job Description:
Summary:
The HCRA Analyst is responsible for administering, monitoring, and analyzing activities of the Lifetime Healthcare Companies related to the New York State Health Care Reform Act (HCRA), Federal Affordable Care Act (ACA), extraterritorial state surcharges and assessments, New York State patient centered medical home incentive payments (PCMH), New York State MCO tax, health risk-based capital filings, and group capital calculation for respective entities. This role ensures compliance with state regulations, supports accurate surcharge and covered lives reporting, reconciles financial data, prepares regulatory submissions, and collaborates with internal and external stakeholders to resolve reporting and reimbursement issues. The analyst serves as a subject matter expert for HCRA regulations and helps identify opportunities to improve reporting accuracy and operational efficiency. This role performs basic financial analysis and/or assists in complex financial analysis for supervisory review throughout the organization.
Essential Accountabilities:
All Levels
Prepares, validates, and submits HCRA surcharges, Covered Lives counts, Non-NY surcharges, assessments, and other required regulatory filings in compliance with state requirements.
Analyzes member eligibility, enrollment, and product data to determine reporting obligations and assessment requirements.
Calculates, validates, and reconciles HCRA surcharges, assessments, and Covered Lives obligations to ensure reporting accuracy.
Monitors HCRA surcharge activity and ensure accurate assessment, payment, reporting, and regulatory compliance.
Reconciles reporting data across enrollment, premium billing, membership systems, general ledger accounts, and regulatory submissions.
Researches and resolves discrepancies related to membership counts, reporting classifications, surcharge calculations, and financial balances.
Prepares accruals, account reconciliations, financial analyses, management reports, variance analyses, and ad hoc reporting requests related to HCRA obligations.
Partners with Finance, Accounting, and internal stakeholders to ensure accurate recording of liabilities and expenses and support month-end close activities.
Utilizes accounting systems, Cognos, and SAS to analyze claims and membership data, develop reporting solutions, and maintain supporting documentation, controls, and procedures.
Identifies process improvement and automation opportunities, perform trend analyses, and support system testing and implementation of regulatory and process updates.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.
Level II (in addition to Level I Accountabilities)
Evaluates financial performance by comparing and analyzing actuals results with plans and forecasts.
Prepares and analyzes quarterly and annual regulatory filings.
Coordinates accumulation and evaluation of data from operational units; accounting records; and outside sources to assist in the development of pricing structures for a variety of company products and services.
Level III (in addition to Level II Accountabilities)
Prepares complex analytical schedules for use by senior leadership in decision making process.
Provides financial support by recommending actions in operational and strategic planning relating to HCRA regulations.
Monitor compliance with HCRA regulations and communicate changes to impacted stakeholders. Monitor regulatory updates and assess operational and financial impacts to the health plan.
Reviews remittance activity and payer contracts to identify HCRA reimbursement discrepancies and investigate to achieve resolution.
Researches and resolve reporting variances, payment discrepancies, and audit inquiries.
Establishes and analyzes financial benchmarks to drive informed budgeting and planning.
Oversees the development and analyses of supporting financial schedules, including preparation of worksheets, maintenance of appropriate backup and documentation for internal control and auditing purposes.
Support internal and external audits by preparing documentation and responding to auditor requests.
Develop and maintain policies, procedures, and controls related to HCRA reporting and compliance.
Minimum Qualifications:
NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
All Levels
Bachelor’s degree in accounting, business administration, finance, data analytics or related field. In lieu of a degree, six (6) years of experience required.
Experience with New York State HCRA, Covered Lives and state assessments reporting strongly preferred.
Knowledge of commercial, Medicare Advantage, Medicaid Managed Care, and exchange products preferred.
Experience working with health plan enrollment, eligibility, claims, or financial data.
Demonstrated financial knowledge and modeling skills.
Ability to establish constructive and collaborative relationships with internal and external staff.
Intermediate analytical skills and problem solving.
Proficiency in MS Office Suite.
Level II (in addition to Level I Qualifications)
Three (3) years of financial analysis experience.
Advanced analytical, critical thinking and problem-solving skills.
Demonstrated experience assessing and implementing process improvement.
Ability to work in an autonomous environment, think critically and manage multiple tasks.
Demonstrated knowledge and skill with SAS Enterprise Intelligence tools (Base SAS, SAS EG, SAS Macro, PROC SQL).
Strong organizational skills and ability to prioritize, multitask, and work in fast paced environment.
Level III (in addition to Level II Qualifications)
Five (5) years of progressive financial analysis experience.
Advanced degree or CPA preferred.
Ability to apply critical thinking to gathering and analyzing information from a variety of sources, developing and testing solutions to complex problems, creating strategic and intentional plans.
Detailed knowledge and understanding of Part 86-1 of the Commissioner of Health’s Administrative Rules and Regulations relating to pools (including Health Care Reform Act of 1996).
Proficient MS Excel skills required.
Demonstrated proficiency with SAS Enterprise Intelligence tools (Base SAS, SAS EG, SAS Macro, PROC SQL). Proven analytics skills, including data mining, evaluation, and visualization.
Physical Requirements:
Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
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In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employ
Compensation Range(s):
Level I: Grade E1: Minimum $62,400 - Maximum $84,000
Level II: Grade E3: Minimum $62,400 - Maximum $106,929
Level III: Grade E5: Minimum $71,880 - Maximum $129,384
The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.
Please note: There may be opportunity for remote work within all jobs posted by the CDPHP Talent Acquisition team. This decision is made on a case-by-case basis.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.