WHO WE ARE:
GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.
POSITION SUMMARY:
Responsible for accounting, analysis, and reporting related to the Company’s health plan business. This includes but is not limited to Premium Revenue, Capitation, Fees and Taxes owed as a result of Premium Revenue, Pharmacy, and other delegate related expenses. Also plays an integral part in the annual financial statement audit.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Premium Revenue:
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Calculates and analyzes premium revenue for all lines of business and posts related entries to the general ledger.
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Reviews, reconciles, and analyzes monthly Medicare Advantage premium data received from CMS.
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Completes monthly Commercial State premium reconciliations timely and analyzes for tax exempt status. Maintains schedule of monthly State member premiums received.
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Reconciles member premium payments.
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Oversees audit function of Eligibility for purposes of accurate membership reporting, premium billing, commissions, and other finance/accounting functions.
Financial Period Closing:
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Completes health plan related audit requests during the annual financial statement audit.
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Assists in monthly closing process for assigned companies, including but not limited to, prepaid schedules, cash and account reconciliations, and expense analysis.
Capitation & Management Fee:
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Calculates capitation expense, management fee expense, and premium tax, and posts related entries to the general ledger.
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Prepares capitation analysis for contracted provider groups.
Other:
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Calculates pharmacy rebates and posts related entries to the general ledger.
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Analyzes delegate invoice detail and approves for AP payment.
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Reviews daily cash entries and posts to general ledger.
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Prepares and submits 1099s
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Prepares and submits 1095s
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Maintains vendor records in accounting software.
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Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
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Performs other duties as assigned.
EDUCATION AND EXPERIENCE:
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Bachelor's degree in accounting or business administration required
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Two years of accounting experience required
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Health or Insurance industry experience a plus
KNOWLEDGE, SKILLS AND ABILITIES:
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Strong Excel skills and analysis skills
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Strong critical thinking skills
- Proficiency in mathematical skills
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Strong organizational, prioritization, and time management skills
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Able to multi-task, work under pressure and meet required deadlines
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Strong verbal, listening, and written communication skills
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Good interpersonal skills and ability to work well with others
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Dependable in attendance and adherence to timelines and schedules
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Possesses attention to detail
WORK ENVIRONMENT:
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Current work environment is remote, however, some state exclusions apply.
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Must have access to a reliable and secured internet connection source. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies.
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May need to visit office location as needed
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Periodic weekend or evening work is expected. May be subjected to fast-paced decision making, crisis situations.
TRAVEL:
No travel required
SUPERVISORY RESPONSIBILITY:
This position does not have any supervisory responsibilities.
OTHER DUTIES:
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.