Navitus Health Solutions
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Financial Analyst, Medicare Part D
at Navitus Health Solutions
LocationAppleton Campus: Appleton, Wisconsin
A minimum of a Bachelors Degree in Finance or Accounting.
Minimum of 5 years' experience of financial reconciliation and analysis in the healthcare industry. Medicare Part D financial management experience preferred. Expertise with financial management tools, business analysis, reconciliations and reporting, with a "track record" of tangible success, including team collaboration/relationship-building or management in a health care or related environment is essential. Experience and expertise in government program compliance highly desired.
This position is responsible for managing financial reconciliations, forecasting and supporting P&L activities for the Medicare Part D EGWP product line. The Financial Analyst (FA) reconciles all financial payments from CMS, third party organizations and employer groups. The FA ensures compliance with all Medicare Part D regulations as it relates to receipts and payments of subsidies, rebates, and/or premiums (if applicable). The FA ensures that the appropriate processes, procedures, and software are implemented to meet these requirements The FA will be responsible for implementing and overseeing the business processes utilized to provide the financial services, including coordinating and project managing workflows; policy and procedure administration; and educating others. The FA acts as the liaison with Client Services, Government Program Operations, and Finance as it relates to subsidy payments, schedules, reconciliations, and forecasting. The FA also leads the development of reporting solutions to meet CMS Reporting Requirements and supports related CMS Data Validation Audits.
- Develops and maintains deep subject matter expertise related to Medicare Part D Enrollment and Payment processing and related financial functions..
- Reconciles monthly CMS reimbursements to the employer group and managing the group level reporting and payments.
- Reconciles monthly Low Income Premium Subsidy (LIPS) payments to the employer group and managing the group level reporting and payments. Manages the LICS, reinsurance and quality assurance reports by client and reviewing with the client as needed. Manages CMS Late Enrollment Penalty (LEP) administration and ensures clients are compliant with CMS regulations related to this process.
- Reconciles the COB User Fee, Material Fee, and PRS (detailed transactions from CMS) from CMS, and through a process, allocates the appropriate fees to each employer group. The Financial Analyst will use a tool to record, track, and manage adjustments.
- Manages the spreadsheets that documents capitation payment reserves and reconciles to subsequent payments to the employer groups.
- Manages the quarterly Coverage Gap Discount Program (CGDP) and annual reinsurance payments to the employers.
- Reconciles CGDP (manufacturer) payments including CMS invoice to manufacturer, manufacturer payments, reporting to CMS, and managing the dispute processes.
- Forecasts EGWP client drug spend trends and Direct Subsidy, GAP, LICS, and reinsurance payments. Primary user of actuarial software used to provide EGWP client drug spend forecasts for prospective clients.
- Conducts annual reconciliations of all subsidies and payments and year end close.
- Oversees cash receipts and distributions
- Reports, as needed, to Plan Sponsor(s), to ensure they meet their fiduciary reporting responsibilities.
- Maintains all policies and procedures that support the financial management and reconciliation processes.
- Administers CMS overpayment processes
- Provides Medicare Part D SME support to Implementation Team for annual and new client implementations.
- Develops, modifies, and improves business processes and policies.
- Employs a "hands on" approach to issue identification and resolution. Utilizes various tools to proactively monitor data quality.
- Support P&L (profit and loss) efforts for the program/products, as directed by the Medicare Program Manager and/or Senior Director of Finance to establish product pricing strategies including base pricing, maintenance and support, and value-added services.