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AVP - Finance (Healthcare)

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Company: Kurz Solutions

Location: San Antonio, TX

Date Posted: April 28, 2014

Source: KURZ Solutions

ASSISTANT VICE PRESIDENT OF FINANCE – HEALTH PLANMultiple Opportunities
- Dallas, San Antonio, Austin, Houston, El Paso,

Albuquerque JOB SUMMARY:
The AVP Finance
- Plan is responsible for owning, managing, and driving the budgeting, forecasting, and financial analysis functions of the health plan to ensure the achievement of membership, premium, medical expense, gross margin, and local SG&A goals on a quarterly and annual basis. Major activities owned by this position include the annual budget, quarterly forecasts, financial statement analysis and interpretation, ownership of the ACT process to maximize gross margin, and participation in the premium rate-setting process. The AVP will work collaboratively with health plan and corporate management in all areas of responsibility to ensure the organization is focused on current results vs. budget, current financial performance trends, and the identification and execution of initiatives to properly manage revenue, medical, gross margin, and SG&A to plan.

PRIMARY RESPONSIBILITIES:

1. Own topline ...

ASSISTANT VICE PRESIDENT OF FINANCE – HEALTH PLANMultiple Opportunities
- Dallas, San Antonio, Austin, Houston, El Paso,

Albuquerque JOB SUMMARY:
The AVP Finance
- Plan is responsible for owning, managing, and driving the budgeting, forecasting, and financial analysis functions of the health plan to ensure the achievement of membership, premium, medical expense, gross margin, and local SG&A goals on a quarterly and annual basis. Major activities owned by this position include the annual budget, quarterly forecasts, financial statement analysis and interpretation, ownership of the ACT process to maximize gross margin, and participation in the premium rate-setting process. The AVP will work collaboratively with health plan and corporate management in all areas of responsibility to ensure the organization is focused on current results vs. budget, current financial performance trends, and the identification and execution of initiatives to properly manage revenue, medical, gross margin, and SG&A to plan.

PRIMARY RESPONSIBILITIES:

1. Own topline, medical expense, and local/direct SG&A portions of annual budget process & quarterly forecastsa. Drive process with Plan leadership in conjunction with CEO/COOb. Conduct/coordinate all analysis required for membership, premium yield, medical expense, and local/direct admin by productc. Provide all required files to Home Office Finance departments within required timeframes2. Provide updated topline and medical projections as needed by the Home Office due to material changes in the business environment (new membership, new product, new provider contract, etc.)3. On a monthly and quarterly basis, provide necessary information to Actuarial for the medical accruals including:a. Large cases not in claim experienceb. Major contract changes not in claim experiencec. Other utilization or unit cost events not in claim experience4. Full participation in monthly operational meetings, financial statement meetings, and medical accrual meetings.5. On a quarterly basis, provide all necessary information for the other known liabilities, including detailed analysis for auditor review, within required timelines of close process.
6. On a monthly basis, analyze, interpret, and communicate financial statement and medical accrual results to plan leadership for the month, quarter-to-date, and year-to-datea. Identify and explain all variances to budget/forecastb. Identify trends & key drivers in revenue and medical and roll them into ACT process for action c. Assess impact on quarterly and full year budget/forecast targets for topline, medical expenses, gross margin, HBR, and pre-tax/pre-corporate earnings7. Own the ACT program and ensure its success for the health plan in achieving revenue, medical, and gross margin targets on a quarterly and annual basis according to budget/forecast8. Conduct and manage all required analysis for the ACT programa. Identify, assess, document, and monitor all opportunities to maximize revenue and manage medical expenses to budget/forecast through membership, premium rate, unit cost, utilization, and cost containment initiatives b. Ensure 150% of gross margin gap to budget/forecast is explained at all timesc. Fully utilize process tools and methodologies in accordance with Corporate standards9. Fully engage with other Plans and Home Office departments to identify, define, and use standard tools and analytical approaches, including use of common data sets. Interaction with Medical Finance, Finance, Medical Management, Claims, Cost Containment, Provider Service Operations, and Premium Reconciliation is expected10. Participate and contribute to “Best Practice” forums with other Plans and Home Office to share initiative successes, share lessoned learned, identify best practices across the company, and identify new initiatives not currently implemented at the Plan
11. Monitor monthly cost containment activity, including investigation and resolution of adverse changes in collection activitya. Provide direction to Cost Containment Unit for additional expense savings opportunities not taken12. Monitor monthly claims production, including investigation and resolution of adverse changes in production statistics and their impact on medical accrual estimates13. Monitor monthly supplemental revenue collections such as Maternity kick payments, Newborn kick payment, and reimbursable drugs, including investigation and resolution of adverse changes in collection activity14. Monitor, analyze, and report any variances for local and direct administration expenses
15. Identify and drive opportunities for savings with Plan leadership on a monthly basis16. Work with Actuarial to understand key drivers of the premium development for each product17. Identify and monitor the assumptions and issues in the rate methodology that drive financial success including trend, populations covered, benefits covered, unit cost assumptions, risk adjustment, birth rates, newborn enrollment rules, special populations (i.e. AIDS/HIV), utilization assumptions, and program changes.a. Communicate to key Plan leadership and ensure they understand the drivers of success underneath the premium ratesb. Monitor performance against quantifiable drivers of premium rates and resolve adverse variances as they arise Education and

Experience:

EducationRequired:
BA or BS in Accounting, Finance, or

Actuarial SciencePreferred:
MBA in Accounting, Finance, or Actuarial ScienceYears and Type of

Experience Required:
10 years of Finance, Accounting, or Actuarial experience including budgeting, financial statement analysis, provider contract analysis, utilization analysis, and basic underwriting and 3 years leadership experience

Preferred:
5+ years of Managed Care Finance, Accounting, or Actuarial experience in a leadership role in a health plan, including responsibility for staff.

Specific Technical SkillsRequired:
Proficient in Microsoft Windows environment including the Office suite of products, proficiency with database programs such as Microsoft Access, advanced skills in Microsoft Excel, advanced analytical skills, and excellent communication skills.

Preferred:
Hyperion Pillar, SPSS or equivalent, SQL One Source Health Careers is committed to improving health outcomes by providing well-managed companies with the top healthcare talent in the market.www.onesourcehealthcareers.com

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