Finance Director


: $205,500.00 - $205,500.00 /year *

Employment Type

: Full-Time


: Financial Services - Banking/Investment/Finance

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Our client is a large healthcare facility with multi-services for the elderly. They are looking for a seasoned Director of Finance with experience managing MLTC Medicare, Part D and all regulatory components of the operation.
Work with PBM/Vendors/Finance to gather and prepare for annual CMS/HPMS submission & attestations: PDE/DIR/P2P, Medical Loss Ratio, Federal Reimbursement, etc.
Assist with annual Medicare BID as needed.
Review daily HPMS/CMS memos and coordinate with internal departments on updates/issues.
Attend Part C & D User calls and Webinars and coordinate with internal departments on updates.
Work with CMS auditors and coordinate with internal departments on Medicare Audits, including Internal Mock Audits.
Maintain monthly CMS Reports (P2P, Plan Payment, Premium & LEP Billing/Reconciliation for all Medicare Plans (ISNP, MAP FIDA)).
Coordinate with Intake Department to ensure LEP letters are generated in a timely manner according to CMS policies.
Provide SVP/AVP of Finance the reconciled Plan Payment Report to certify monthly Roster in HPMS and reconcile revenue.
Coordinate with Finance/Enrollment Dept. in maintaining monthly Medicare Secondary Payer (MSP) reports.
Coordinate with TPA/IT in maintaining the monthly Elderly Pharmaceutical Insurance Coverage (EPIC) remittance files.
Assist VP of IT with Milliman Gap Analysis
Audit PBM weekly invoice.

Work with PBM/TPA and oversee the following:

Manufacturer Disputes: to resolve PDE Actionable Items posted by Acumen
General CGDP Data Quality Review
Part D Payment Reconciliation Data Quality Review
PDEs Withheld from CGDP Invoices

Coordinate with internal departments to create and maintain the following Policies and Procedures (PnP's):

P2P process
Late Enrollment Penalty (LEP) process
Acumen PDE Analysis
PDE Error reconciliation process
Risk Adjustment Payment System (RAPS) process
Quarterly Coverage Gap Discount Program (CGDP)
Medicare Secondary Payer (MSP)
Low Income Subsidy (LIS)
Monthly Plan Payment process (MMR)
Member Recovery Program
Medicare Stop Loss Claims (when members reach 3K)

Bachelor's Degree
Prior Experience and knowledge

Company Description:

At HumanEdge, we create great hiring experiences for candidates and clients alike. We do it by applying our skills, energy, integrity and understanding of both individual needs and market forces to make the right match for all types of positions, including traditional contract assignments, career-changing direct searches, and freelance gigs. We know that youre more than a skill set and cluster of job experiences youre a whole person with big dreams and ambitions. When you work with us, you partner with a firm committed to helping drive your success with ongoing support, guidance, and tangible opportunities. For over 30 years we've helped candidates like you make the right move in a wide array of industries and variety of positions

Associated topics: chief financial officer, chief investment officer, director finance, general manager, operation, operational manager, president finance, senior director, staff, supervise * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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