Overview

About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief Summary of Purpose:

The Medical Accounting Senior Accountant (MASA) is a strategic partner to management across the organization. The role requires proficiency in the development, accumulation, and evaluation of key elements necessary to properly report the financial position of the organization. The MASA is responsible to maintain the general ledger’s accuracy by creating, processing and/or recording business transactions. They will work with senior members of the organization to gather all relevant data required to verify balance sheet accuracy. The role requires a robust knowledge of accounting, reporting, financial modeling, and analytics. The MASA will support business segment senior management as Fallon Health continues to ensure the long-term fiscal viability of its organization. In addition to reviewing, approving, and preparing standard financial reports, the MASA will be required to review, approve, and prepare ad hoc management analysis or provider / vendor metric reports. The role requires the MASA to research, understand, and interpret accounting concepts and possess the ability to aid in operationalizing those concepts in matters specific to the health insurance industry. In order to ensure compliance with State and Federal statute, the MASA will review, prepare, and file regulatory reports and provide supporting documentation upon audit as necessary. The MASA will be responsible for the successful completion of major segments of internal and external auditors and will make certain to aid in the design and operation of a strong control environment with the goal of minimizing the presence of any material financial reporting misstatements.

The MASA will employ a highly developed expertise in exercising their finance duties as they contribute to the execution of corporate objectives. They will use their extensive knowledge base to address a diverse range of complex problems, gather and analyze relevant data and exercise good judgement as they assist in the development of appropriate recommendations and solutions. The MASA has latitude in planning and executing their workload and will operate with limited direction within well-defined environment of policy and practice. It is expected the MASA must be able to interact successfully with management and senior personnel across various departments.

Responsibilities

Primary Job Responsibilities:

• Works seamlessly within the general ledger system to record transactions in order to appropriately report the financial activity of the

• Perform complex internal account reconciliations with a high degree of

• Has 6+ years of experience and can demonstrate an understanding of GAAP concepts, practices and procedures

• Has 6+ years of experience and can demonstrate an understanding of State specific accounting concepts, practices, and procedures necessary for regulatory reporting (STAT)

• Extract data from internal and external systems and analyze financial results – is comfortable creating, modifying and executing basic data scripts and queries in order to ensure appropriate support for keyfinancial figures.

• Report financial results to management and offer strategic insights

• Develop and present actionable recommendations and solutions to management that will impact results

• Prepare vendor and provider capitation payments

• Prepare risk settlement accruals and payment journal entries

• Responsible for all RX Rebate journal entries and payments

• Responsible for all IBNR journal entries and reconciliations

• Other medical entries and tasks as required

• Responsible for preparing the Underwriting and Investment Exhibits for statutory reporting

• Responsible for assigned account reconciliations utilizing the Blackline Software

• A core liaison for both internal and external audit processes – ensure timely coordination and the delivery of all staff specific requirements, prepare / review work papers and financial statements to ensure they are free of material misstatement, aggregate and/or prepare appropriate supporting documentation, create proposed footnote disclosures as required by accounting guidance and operate within an environment of strong internal controls

Qualifications

Education:

Bachelor's Degree in Accounting or Finance

License/Certifications:

MBA/CPA preferred but not required, relevant experience will be considered

Experience:

Demonstrated proficiency in performing accounting, reporting, financial modeling, and analytic assignments:

• At least 4-6+ years of experience in a managed care environment (will consider other relevant health care, social service, insurance or not-for-profit experience)

• Experienced user of software applications necessary to achieve job requirements (ex. Oracle, Adaptive Insights, Business Objects, )

• Microsoft Office super-user

Strong knowledge of the following:

• Medicare, Medicaid (ACO / MCO) and other government programs

• GAAP and Statutory reporting requirements

• Consolidation accounting and advanced accounting concepts

• ACA reporting and expense requirements

• Actuarial concepts such as IBNR claims and PDR

• MAR, Independent Financial and SOC 1 audit requirements

• Work flow and internal controls

• Risk adjustment and encounter data

Resources:

Microsoft Office Excel, Word, Power Point. Oracle Fusion Financials. Report writing software. Ability to extract data using internal resources – (ex. QNXT, EDW, Alteryx, Business Objects, etc.)

COVID-19 Vaccination:

With the end of the Global Coronavirus COVID-19 Pandemic, Fallon Health no longer requires all employees to be vaccinated against COVID-19 except for employees who are in jobs that under state and federal laws, regulations and policies are required to be vaccinated and/or they are in Member/participant facing positions.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

#P01

Location US-MA-Worcester

Posted Date 2 weeks ago (5/5/2024 7:09 PM)

Job ID 7575

# Positions 1

Category Finance