Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Government Programs Product Performance Manager

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Manager & Professional
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190QY Requisition #
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Monitor financial performance of Government Programs Product (Medicare and Medicaid) to ensure that each product is performing as expected. Working with Actuarial/ Finance team in ensuring the integrity of general ledger and preventing write-offs. Oversee performance of individual Government Programs products designed to drive membership growth/retention, improve MLR, improve operating margin. Ensure the integrity of enrollment and disenrollments, ensure appropriate processes are in place for revenue capture and monitor revenue enhancement, i.e. NH (Caid), Kick (Caid), MSP (Care), ESRD (Care). Drive the development of requirements and new processes to support operational effectiveness and efficiency for Medicare and Medicaid to meet contribution margin targets. Recommend plans to implement new/modified process for P&L enhancement in conjunction with cross-functional leaders at all levels throughout the enterprise. Support Government Programs financial performance improvement initiatives with financial modeling, cost benefit, and ROI analysis.

 

Responsibilities:

  • Analyze performance of key financial drivers and identifies areas for improvement. Deconstruct rate sheets and evaluates the impact to the P&L, perform financial modeling.

  • Perform financial modeling, ROI analysis, cost benefit analysis, of new and existing programs.

  • Ensures the integrity of the monthly financials across government programs, identifying opportunity for improvements for the business areas through the review.  Ensures write-offs are identified in advance and that processes are put in place to minimize write-offs.

  • Owns the membership numbers for Government Programs from an integrity point of view, performing monthly analysis of variances and trends. Provides leadership with insight into enrollment and disenrollment trends.

  • Work with business owners to identify opportunities to improve revenue, quality measure performance, contracting and provider performance, and to reduce medical costs.

  • Develops financial performance metrics to build transparency into financial performance of Government Programs. Analyzes results, identifies opportunities, areas for improvement, and strategies to optimize financial performance.

  • Oversees revenue enhancement opportunities; monitors ongoing financial valuation and billing/correction of: Medicaid: Underpayments resulting from eligibility gap errors, denied premiums, and Nursing Home provider payment recovery.  Medicare: MSP recovery and outreach (revenue and COB), ESRD, and other opportunities.

  • Serve as EmblemHealth’s financial SME, interfacing with (external) NYS DOH/ CMS and (internal) Medicare/ Medicaid leads to mentor and develop staff; and to facilitate understanding of Medicare program goals and objectives across the organization.

Qualifications:

  • Bachelor’s Degree required

  • MBA or equivalent preferred

  • 5+ years of relevant work experience, including positions of increasing scope and responsibility required

  • 5+ years of government programs healthcare experience required

  • Experience in using metrics and analytics to quantify goals and results, and in presenting information in usable form required

  • Excellent communication skills (verbal, written, presentation), including the ability to negotiate and persuade, with all levels and types of audiences, both internally and externally required

  • Industry level knowledge of Medicaid and Medicare rules, regulations, and processes preferred

  • Demonstrated ability to effectively execute on multiple competing priority items/tasks/projects required

  • Working knowledge of program management preferred

  • Proficiency in MS Office suite (excel, word, access, power point) and analytics/ programming (SAS, SQL) required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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