Ensures all Regulated Market adjustments are reviewed and processed within CMS guidelines and contractual turnaround times
Perform financial analysis review of adjustment extract criteria and impact report results
Financial reconciliation of adjustment processing to closure of adjustment requests
Deliver delegated tasks by the Financial Operations Manager and complete day-to-day financial operations tasks independently
Create reports in accordance with laws, regulations, and financial auditing controls and prepare reporting for distribution
Use Excel to create pivot reports and filters for financial analysis
Assist with triage, high dollar reviews, and daily file uploads as needed
Ensure adjustments are accrued timely and properly for direct assignments
Resolve non-routine issues escalated from cross-functional partners and communicate with requestors including client service delivery, product and account management
Requirements
Must be within driving distance to Morris Plains, NJ office
Bachelor's degree in Finance, Accounting, Statistics, Business or other related field or equivalent work experience
2+ years relevant experience in finance, claims adjudication, or project management preferred
Experience in Healthcare, Insurance, Pharmacy, Medicare, Medicaid, CMS highly preferred
Advanced Excel skills, including experience with large data sets, pivot tables, VLookup, and macros
Experience with Power BI and Tableau a plus
Excellent problem solving skills and attention to detail
Ability to communicate effectively internally and cross functionally on both technical and non-technical aspects of the business
Excellent judgment, communication, interpersonal and organizational abilities
Ability to be flexible, agile, and manage complex processes
If working at home, internet via cable broadband or fiber with at least 10Mbps download/5Mbps upload
Benefits
medical
vision
dental
well-being and behavioral health programs
401(k) with company match
company paid life insurance
tuition reimbursement
minimum of 18 days of paid time off per year
paid holidays
eligibility to participate in an annual bonus plan
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.