Staffing Solutions Organization LLC (SSO), an affiliate of Public Consulting Group LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve.
DHPCO - 1022
Summary
This individual will assist the Department of Health’s Office of Health Insurance Programs (OHIP)/Division of Health Plan Contracting and Oversight (DHPCO) in development, analysis and oversight associated with the Medicaid Managed Care Operating Cost Reports for Medicaid and Managed Long Term Care (MLTC) plans, Medical Loss Ratio Reporting and Oversight as well as overall plan solvency.
Basic Responsibilities:
- Responsible for the daily activities related to ensuring Managed Care Organizations (MCOs) in New York State are compliant with State and Federal laws, regulations and policy related to health plan fiscal oversight.
- Assist in the development of quarterly financial reports to collect financial information from the Medicaid Managed Care Organizations (MCOs) in NY inclusive of Medical Loss Ratio reporting and oversight.
- Review and oversee timely filing and accuracy of all MCOs financial reporting.
- Conduct reviews of MCOs financial reporting and operating status, including compliance with Public Health Law, regulations, and policies as well as the federal regulations.
- Communicate findings and collaborate with MCOs to improve accuracy of financial reporting.
- Review and Evaluate plan Solvency.
- Review and evaluate MCO expansions, mergers, and acquisitions for MLTC and Mainstream plans.
- Review and evaluate MCO provider and management contracts for compliance with the financial standards and requirements in PHL.
- Review provider risk contracts (including VBP), Management Service Agreements (MSAs), intercompany agreements and Care Management Administrative Services (CMAS) agreements for the assigned MCOs as to their compliance with financial rules and policies.
- Assist in automating and standardizing financial reports for analysis of fiscal status of the MCO.
- Develop ad-hoc financial reports extracting data, as necessary.
- Perform research and comparison of applicable State and Federal rules and study best practices in relation to monitoring of plan financial solvency, as well as be responsible for evaluation of MCO Service Area Expansions, addition of new lines of business and mergers and acquisition applications.
Additional Requirements and Day-to-Day Tasks of Position
- Strong Excel and data analytics skills.
- Strong communication skills (written and oral).
- Ability to present data to parties with varying backgrounds.
- Ability to work independently.
Education:
- Bachelor’s degree in business, finance, accounting, or related field.
- Two (2) years of work history in finance or healthcare.
Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides a reasonable range of compensation for this role. In addition, SSO provides a range of benefits for this role.
Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an Employment Visa at this time.
All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an e-Verify participant.
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