Emory University je raziskovalna univerza v Atlanti v Georgii z akademskimi in strokovnimi programi s področij umetnosti, naravoslovnih ved, poslovanja, prava in medicine. Njeno delovanje povezuje izobraževanje z zdravstvom in znanstvenim raziskovanjem ter v širokem univerzitetnem okolju združuje poučevanje, ustvarjanje znanja in služenje skupnosti.
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.
Opis
- 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.
Zahteve
- 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.
Ugodnosti
- 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.