Market Finance Lead

Job Description Summary

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The Finance Manager serves as the key financial liaison with risk affiliated entities, ensuring accurate financial execution, compliance, and transparency. This role is responsible for overseeing Incentive Pool calculations, payment integrity, audit preparedness, and financial reporting related to Medicare Advantage, ACO, and value-based arrangements.

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How will you make an impact & Requirements

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• Track and validate all Incentive Pool calculations, including attributed revenue, medical expense, incentive payments, and initial startup costs.
• Provide verification support for contractual audit rights and maintain line-item expense transparency for items in excess of reasonable thresholds.
• Provide monthly reporting around Financial performance and operational metrics associated with Medicare Advantage and Medicare ACO contracts.  Operational metrics include address rate, recapture rate, and admits per 1000 (admission, discharge, and keep metrics).
• Ensure timely incentive payment calculations, annual reconciliations, and performance reporting as outlined contractually.
• Document and manage offsetting of surpluses/deficits under Incentive Pool.
• Support decision-making and documentation for renegotiation events.
• Ensure accurate tracking of IBNR reserves, Payor Adjustments, and retroactive adjustments in accordance with contractual requirements.
• Track and reconcile incentive payments tied to burden of illness. Collaborate with Accounting on monthly journal entries for incentive activity and coordinate with Treasury for timely payments.
• Oversee receipt and accounting of risk-based and shared-savings revenue.  Reconcile direct fee-for-service receipts, ensuring clear segregation between FFS and value-based revenue streams.
• Manage responses to third-party payor and government audits.  Provide detailed supporting schedules and reconciliations for any financial audits requested.
• Manage invoicing, cash flow, and ongoing communication with for employee lease arrangements. 
• Continuously evaluate financial performance to identify early indicators of performance variance.  Support senior leadership in evaluating performance.