Senior Financial Analyst - PFK Business Services

Columbus, OH, United States

Overview

Partners For Kids (PFK) is a physician hospital organization currently composed of more than 900 physicians caring for approximately 300,000 children and adolescents, including primary care physicians, pediatricians, specialty care providers and our sponsoring hospital, Nationwide Children’s Hospital (NCH).

The Senior Finance Analyst is responsible for reporting and analysis of capitation revenue and claims expense for the more than $900 million that flows through PFK on an annual basis. This position will work with the financial and actuarial counterparts within the 5 Managed Care Plans (MCPs), all affiliated companies and organizations, PFK’s actuarial services vendor, and PFK’s data management vendor. Major responsibilities include, but are not limited to, performing audit and internal controls on invoices and data received from the MCPs, capitation and chargeback reporting, supporting the presentation of monthly updates to Senior Leadership on cost trends and financial risk management, ensuring capitation, eligibility and claims data integrity, maintaining reinsurance processes and escrow accounts/reserves, and ad hoc financial modeling or project leadership as requested by the Manager of Finance, VP of Operations, and President.

Why Nationwide Children's Hospital?

The moment you walk through our doors, you feel it. When you meet our patient families, you believe it. And when you talk with anyone who works here, you want to be part of it. Welcome to Nationwide Children’s Hospital, Where Passion Meets Purpose .

Here, Diversity, Equity and Inclusion are integrated into our core values and practices. We are passionate about building, sustaining and evolving an inclusive and equitable environment. We are seeking individuals who live these values and want to share their experiences and efforts in support of our collective mission.

We’re 14,000 strong. And it takes every one of us to improve the lives of the kids we care for, and the kids around the world we’ll never meet. Kids who live healthier, fuller lives because of the knowledge we share. We know it takes  a Collaborative Culture  to deliver on our promise to provide the very best, innovative care and to foster new discoveries, made possible by the most groundbreaking research. Anywhere.

Ask anyone with a Nationwide Children’s badge what they do for a living. They’ll tell you it’s More Than a Job . It’s a calling. It’s a chance to use and grow your talent to make an impact that truly matters. Because here, we exist simply to help children everywhere.

Nationwide Children’s Hospital. A Place to Be Proud .

Responsibilities

MONTHLY

•        Support and record the approximately $35 million monthly wire transaction process between the MCPs and PFK

•        Prepare a detailed reconciliation of the capitation and chargeback statements produced by each of the 5 MCPs, ensuring that PFK is receiving the appropriate cap rates and to explain month-to-month variances.

•        Partner and work with affiliates and vendors to forecast cash flow and the monthly reserve amount, detailing the drivers behind material gains or shortfalls and changes in membership.

•        Prepare and record journal entries for monthly accounting purposes.

•        Perform internal control and audit procedures to ensure MCP invoices, wire transfers and data files are accurate.

•        Work with MCP contacts to resolve questions, errors or anomalies.

•        Support the preparation and presentation of monthly financials and other reports to Senior Leadership, focusing on:

•        Identification of cost containment opportunities through analyzing and interpreting per member per month (PMPM) expense trends, detailed analyses of variances by region, program, and payer, and highlighting any known changes to Ohio Medicaid that impact the financial risk assumed by PFK and recommending strategies to impact variances.

•        Partner with  actuarial services and data management vendors to prepare, reconcile, analyze and interpret monthly financial statements and IBNR

•        Function as a PFK financial liaison during the preparation and evaluation of actuarial and accounting statements provided by actuarial services and data management vendors, communicating all relevant financial risk management information to the Manager of Finance and PFK Senior Leadership.

•        Work with PFK’s data management vendor and PFK staff to resolve questions regarding variances in monthly financial statements.

ANNUAL OR QUARTERLY

Budget – assist in the management of the annual budgeting process for PFK, evaluating and projecting the operational resources required for all administrative and clinical functions.

•        Assist with the review and analysis of the ODM rate book.  Prepare and assist in communicating changes in rates that have material impacts on future budgets.

•        Work with MCP contacts to update rates in accordance with the most current contracts.

Policy and Procedure – assist in the maintenance and documentation of all policies and procedures related to PFK finance and internal controls.

Annual Financial Audit – assist with the audit procedures and analysis related to the annual financial audit.  Gather documentation as requested and facilitate communication with MCP’s as necessary.

990 Tax Preparation – assist with the preparation of the annual form 990.

Reinsurance – assume accountability for the reinsurance process, including oversight of claim submissions and the annual renewal process.

OTHER & ONGOING RESPONSIBILITIES

Financial Modeling & Ad Hoc Reporting – build detailed financial models to support:

•        Contracting – ex. Administrative allowance renegotiation, escrow analysis for new health plans, etc.

•        Business Development & Competitive Analysis – ex. Market share reporting, benchmarking managed care reimbursement at non-NCH facilities, providing PFK financial guidance to business plans as requested by Senior Leadership.

•        Other Initiatives as Requested by the Senior PFK Leadership Team

Project Support – take an active role in projects to reduce cost of care or improve data quality and efficiency.

Data Integrity – provide analytical support to validate eligibility and claims data platforms.

Other duties as required.

Qualifications

MINIMUM QUALIFICATIONS

Bachelor’s degree in Accounting required, Masters or CPA preferred.

Experience in healthcare finance or related field preferred.

Proficiency in Excel and Access required.

Proficiency in SQL preferred.

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