Specifications include, but are not limited to: • Review and analyze the required report filings received by the Managed Care Organizations (MCOs) and provide a summary of review notes and recommendations for the Supervisor. • Reconcile the Medical Loss Ratio (MLR) quarterly. • Assist with oversight of the MLR audit by third parties and assist with review and communication among the parties including the agency, third party CPA firm and the MCOs. • Participate in meetings as needed with the agency, Fiscal agent, actuaries, third party CPA firm, and other external parties. • Prepare and review financial transactions and letters. • Review and analyze the Quality Incentive Payment Program (QIPP) reports and assist with the annual presentation. • Assist in preparing and overseeing state directed payments to the MCOs. • Answer questions to the providers related to QIPP and state directed payments, which may include additional report preparation. • Review and assist with filings with the Centers for Medicare & Medicaid Services (CMS). • Prepare reports annually reporting the Managed Care spend by the agency. • Prepare or review reconciliations related to financial transactions. • Prepare and update the accounts receivable monthly related to state directed payments. • Prepare and analyze agency expenditures monthly providing variance explanations for material changes. • Participate in special projects as needed.
