We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

Responsibilities

1.        Prepare all OP, home health, CCSHCN and organ acquisition settlements on an annual basis (approximately 75 settlements).  This requires oversight of the monthly paid claims listing submissions to the state, obtaining the annual cost report from each entity, preparing the calculations for review by the plan finance leadership, distributing to each entity for review, obtaining sign off from each entity once the calculations are agreed upon,  distribution of payment to each entity and once payment is received or paid, ensuring the claims are marked as settled in QNXT (with attribute, the claim cannot be adjusted further).  Above description accounts for a smooth settlement calculation, not any issues that might need to be resolved along the way.

2.        Collaborate with Finance Central Reporting on Medicaid Finance state reporting requirements, including but not limited to: reporting used by the state for lock in program evaluation, capitation payments and RFI adhoc requests. The state reporting requirements are outlined per our contract with the state.  This requires an understanding of the state report and the ability to analyze the data for accuracy prior to submission.

3.        Finance contributions to monthly reserves or other analytic reporting – reconciliation of invoices/claims paid to data housed in plan audit tables

4.        Prepare all off lag accrual inputs for the Central Accounting team (P4Q, shared savings, capitation, settlements (OP, home health, CCSHCN, organ acquisition, vision risk corridor, etc).  Once the financial statements are complete, prepare the off lag information needed for restatement analysis and ensure it ties out once prepared by Finance Central Reporting.

5.        Monthly premium reconciliation – prepare the reconciliation for sign off; review the detail records to determine what needs enrollment updates, requires discussion with the state for potential system changes or needs further research by the plan Finance team to determine next steps. Overall, ensure all premium dollars are received as anticipated.

6.        Prepare the monthly lock in payments for network providers, as applicable.

7.        Prepare quarterly NAIC benchmark reporting (comparison to competitors)

Education

Bachelor Degree

Other License(s): CPA

Prior Relevant Work Experience

3 to 5 years 

Essential Qualifications, Essential Functions & Preferred Qualifications

• The Americans with Disabilities Act (ADA) was designed to provide equal employment opportunities for qualified individuals with disabilities.  The ADA not only prohibits discrimination against qualified applicants and colleagues on the basis of a disability, but also requires employers to provide reasonable accommodations which will enable a qualified individual with a disability to perform the essential functions of the position that person holds or seeks.

•  In order to ensure compliance with the ADA, CVS Health’s job descriptions should identify the essential functions of the position.  These job descriptions can then be used for recruitment and selection, and to help determine reasonable accommodations and return to work arrangements. 

• Essential job functions are the fundamental duties of a position.  A colleague must be able to perform these job functions in order to meet the requirements of the job.  Job descriptions should be kept current and capture essential functions that colleagues may be required to perform.

• Determining the essential functions may involve consideration of the frequency with which a function is performed, the work environment itself, and the resulting consequences if the function is not performed.

·         Physical factors— type of environment associated with job: indoor/outdoor.

·         Working conditions—shifts, overtime requirements as needed, travel requirements.

• Determining the essential functions may involve consideration of the frequency with which a function is performed, the work environment itself, and the resulting consequences if the function is not performed.

Knowledge of:

• Healthcare, managed care insurance or financial services

• Financial planning and analysis; Accounting principles

• Medicaid products and financial drivers

• P&L ownership and key financial metrics

Skill In:

• Financial management experience including business planning, accounting and financial analysis.

• Collaboration with functional areas to drive results

• SQL

Ability To:

• Influence people across the enterprise

• Resolve problems and influence decisions on customer issues

• Present to internal and external customers

Additional Requirements:

• Regular and reliable attendance

• Additional tasks as directed by manager

Preferred Qualifications

Knowledge of:

·         Health Insurance industry, preferably in Medicaid

Skill in:

• MBA, CPA, FSA or equivalent is helpful but not required

• Project management and process improvement skills preferred

Ability To:

• Project management and process improvement skills preferred

Our diverse work experience empowers colleagues for career success. In addition to skill and experience, we attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.

CVS Health is an equal opportunity/affirmative action employer. Gender/Race/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for or perform this job, please contact our Advice and Counsel Reasonable Accommodations team at AdviceCounsel@cvshealth.com.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.