Controller - Health Plan

Director Controller

Hybrid

Summa Care - 1200 E Market St, Akron, OH | Full-Time / 40 Hours / Days

Responsible for the leadership of overall health plan financial operations, including all elements of financial reporting, accounting, budgeting, forecasting, benchmarking, investments, and TPA accounting. Ensures internal and external financial reporting needs are met in accurate and timely fashion. Ensures financial reporting meets Generally Accepted Accounting Principles (GAAP) and Statutory Accounting Principles (SAP). Works closely with the health plan CFO on financial decisions and presentations for Senior Management, Summa Health System leadership team, the Board of Directors and the Audit Committee.

• Formal
  
  Education Required:
  
  
  • Bachelor’s Degree
  • CPA license or 4 additional years of experience
• Experience and Training
  
  Required:
  
  
  • Ten (10) years’ experience to include management of Accounting department, financial reporting, budgeting, forecasting, benchmarking, auditing, cash management and other fiduciary activities.
  • Five (5) years direct supervision of staff.
  • Three (3) years of experience working for a health insurance/health plan, consulting with, or auditing said companies.

• Develops and maintains regular financial reporting procedures, for six companies with annual revenue (premium equivalents) of approximately a half a billion dollars, to ensure timely reporting of financial results to the CFO, Senior Management, Summa Health System leadership team, the Board of Directors, federal/state/local regulatory agencies, and other external users.
• Oversees the preparation of timely and accurate accounting and financial reporting for 6 companies, conforming to Generally Accepted Accounting Principles (GAAP) and Statutory Accounting Principles (SAP).
• Develops and maintains an effective system of internal control that ensures compliance, safeguarding of assets, and integrity of financial reporting.
• Oversees the process of administrative cost allocations, ensuring that costs are appropriately allocated to each of the 6 health plan companies in a manner that is appropriate and auditable.
• Oversees the preparation, reporting and monitoring of the annual budget, monthly forecasts and the annual administrative cost benchmarking (Sherlock report) for all six companies. Creates proforma statements to analyze the impact of contemplated business changes.
• Work collaboratively across all functional areas and across all System companies to assure stakeholders understand the health plan’s financial position so educated decisions can be made. Be a resource and advisor to management both within Summa Care and within Summa Health System.
• Develops and maintains relationships with both external auditors and federal/state regulators in ensuring that annual audits and reviews yield successful outcomes. This includes, but is not limited to, the annual financial audit by RSM, CMS bid audits, CMS financial audits, Marketplace ACA audits and the Ohio Department of Insurance audits.
• Reviews the Accounting team’s recommendations and ensures appropriate analysis in completed and appropriate accounting is applied to very material judgements and estimates including, but not limited to:
• Claims Reserves:
  Analyze monthly claims payments, claims inventory, Summa Health volumes and other data to make sound decisions on the monthly claims incurred but not reported estimate.
• Accrued CMS Revenue:
  Work with all Finance areas to ensure accurate revenue recognition and projections including Medicare mid-year and annual reconciliation, Medicare Part-D reconciliation and ACA Risk adjustments.
• Value Based Contracts:
  Drive across the organization to ensure that all VBC are identified and accounted for consistently with the terms of each contract and appropriate assumptions are used for each component. This includes, but is not limited to, significant judgement around appropriate assumptions around applicable claims reserves and accrued revenue.
• Develops long- and short-term departmental goals, and ensures that assigned function is staffed to meet the current and future needs of the organization. Ensures same are consistent with philosophy…