Emory University yra Atlantoje, Džordžijos valstijoje, įsikūręs mokslinių tyrimų universitetas, kuriame vykdomos akademinės ir profesinės programos apima menus, gamtos mokslus, verslą, teisę ir mediciną. Universitetas sieja švietimą su sveikatos priežiūra ir moksliniais tyrimais, derindamas mokymą, žinių kūrimą ir tarnystę bendruomenei plačioje universiteto aplinkoje.
Senior Director of Financial Operations and Actuarial Strategy – Emory Health Plan
Lead financial operations and actuarial strategy for Emory Health Plan, overseeing vendor controls, compliance, reserves, and reporting. Direct pricing and audit work while building and managing a growing team.
Aprašymas
- Oversee the financial infrastructure, controls, and operations for Emory Health Plan’s medical, pharmacy, and administrative costs.
- Establish and maintain financial systems, reporting schedules, budgeting processes, vendor controls, and regulatory compliance frameworks.
- Lead financial management of vendors.
- Direct invoice reconciliation for third-party administrators and pharmacy benefits managers, including payment accuracy and integrity controls.
- Monitor vendor financial results, contract compliance, unit costs, and administrative fees.
- Review and interpret contract finances, identify risks, and align terms with budget assumptions.
- Assist senior leaders with negotiations involving third-party administrators, pharmacy benefits managers, and stop-loss carriers.
- Lead regulatory compliance and maintain programs for applicable self-funded plan rules.
- Oversee regulatory and state filings, audits, compliance records, and internal controls.
- Advise senior leaders on incurred-but-not-reported reserves, claims lag, and pharmacy rebate accounting.
- Develop and maintain incurred-but-not-reported reserve reporting and reconciliation with external actuaries.
- Set accounting methods for pharmacy rebate accruals, claims runout, and complex reserve items.
- Contribute financial inputs and operational and claims analysis to annual rate-setting and pricing.
- Provide financial inputs for stop-loss reporting and benefits design models.
- Manage and develop the team, including hiring and directing additional staff.
Reikalavimai
- Bachelor’s degree in accounting, finance, health administration, business administration, or a related discipline.
- At least nine years of progressive experience in health plan finance, managed care finance, or related healthcare financial operations.
- Strong experience with financial controls, reporting, and accounting.
- CPA or comparable accounting credential preferred.
- Master’s degree in business administration, health administration, or a related discipline preferred.
- Knowledge of self-funded plan regulations, including ERISA, HIPAA, the ACA, Consolidated Appropriations Act transparency rules, and Mental Health Parity requirements.
- Experience with incurred-but-not-reported reserve management, claims lag analysis, pharmacy rebate accounting, financial controls and reporting, accounting, regulatory filings, audits, and vendor financial management.
- Ability to lead and develop a team, hire and direct additional staff, and manage performance.
Privalumai
- Regular full-time employment.
- Remote work classification, with monthly remote status.
- Occasional supported visits to an Emory University location.
- Equal opportunity employment.
- Reasonable accommodations for qualified individuals with disabilities.