Job Title

Job Family

Job Code

Job Exempt

Health Services Financial Manager

Non_Bargaining

AHM55

Pay Grade

Pay Rate Type

Minimum

Midpoint

Maximum

NB116

Salary

$41.45

$52.85

$64.25

Job Description

Performs professional administrative work managing financial activities associated with a self-funded employee healthcare program. Performs audits of financial and employee eligibility records, financial analyses, and forecast development. Produces comprehensive reports and makes presentations. Works closely with the City of Orlando’s benefits consultant(s),actuaries, Employee Benefits Section, and Budget Office in monitoring compliance and the financial status of the medical plan and other insurance products. Work is highly independent and performed under the general direction of the Human Resources Assistant Manager. Work is reviewed through conferences, reports submitted, and results obtained.

Minimum Qualifications:

Bachelor's Degree in Finance, Business, Accounting, or related field plus a minimum of four (4) years professional experience performing detailed financial analyses, forecasting, financial and program records audits, or related duties; or an equivalent combination of education, training, and experience. Must be proficient in the use of computers and Microsoft business applications, including Excel and Access.

Responsibilities

EXAMPLES OF WORK PERFORMED:

Note: The listed duties are only illustrative and are not intended to describe every function that may be performed by this job class. The omission of specific statements does not preclude management from assigning specific duties not listed if such duties are a logical assignment to the position.

Analyzes and reports healthcare program financial, utilization, trends, and eligibility information to Division Manager, Benefits staff and Ad Hoc Advisory Committee.

Prepares monthly medical plan eligibility and premium reconciliation; authorizes payment as appropriate.

Develops audit procedures and plans; conducts random audits of claims, eligibility records, etc.

Prepares monthly financial statements.

Monitors and reports on benefit plans performance guarantees, as applicable.

Prepares, submits, and monitors the Human Resources budget and expenditures

Analyzes current and proposed regulations, policies, and procedures to determine impact on the healthcare program; makes recommendations to deal with financial and operational concerns.

Assists in development of “Request for Proposal” and evaluation of proposals/bids for services that support medical and other related benefit programs.

Coordinates data flow and assistance with benefits consultant, actuaries and auditors.

Serves as project manager and assigns project task to other HR staff; monitors progress and ensures that work is accomplished according to established plans/objectives; and reports upon completion of project.

Conducts process/workflow analysis to ensure efficient and effective operations.

Provides support to Employee Benefits Section in monitoring compliance of the healthcare plan and other insurance products; supports employee benefits functions.

Monitors and manages compliance with Affordable Care Act for all City's active employees, retirees, and dependents in accordance with IRS guidelines; prepares 1095-B and 1095-C forms for over 9,000 covered individuals; follows up with SSN/name error corrections with IRS after submission; researches repeated discrepancies and reaches out to policy holders to prevent future occurrence; and responds to IRS audit questions about submitted records and communicate with IRS to resolve.

Processes Citywide firefighter cancer claims in accordance to Florida Senate Bill 426; conducts initial review of the application; prepares the packets for review by the medical director and committee members; facilitates Committee meetings and provides meeting minutes; and coordinates with Benefits, Payroll, and Records upon approval. Keeps track of approval/denial history and amounts, as well as answering questions and communicating with applicants, fire fighter representatives, and Committee members.

Provides data and conduct reconciliation of GASB reporting (OPEB benefits); assists with 112.08 actuarial reporting to the Florida Office of Insurance Regulation

Facilitates and serves as City's main contact for the medical and pharmacy claims audit.

Closely monitors City's employee appreciation and team building program fund on a regular basis; s all expenses from each department follow the guidelines and are within the allocated budgeted amount.

Works with benefits consultants and UHC to file required report for the City with the Center for Medicare and Medicaid Services in compliance with Consolidated Appropriations Act; prepares required plan and prescription drug data for the report; and submits with UHC.

Researches and provides data for public records requests related to the health plan.

Conducts medical FSA and dependent care FSA reconciliation; transfers the forfeitures to the appropriate fund; investigates the unsubstantiated claims; and answers questions from employees.

Provides unclaimed property report to Procurement for any unclaimed checks over $10 in accordance to Chapter 717, Florida Statutes and Chapter 59I-20, Florida Administrative Code.

Informs employees in various departments about medical plan design changes; answers questions related to those changes.

Assists with Patient-Centered Outcomes Research (PCORI) report to IRS; provides data for average number of lives covered under the plan; and prepares Form 720 for submission to IRS.

Performs other duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES:

Knowledge of generally accepted accounting principles and practice.

Knowledge of budget preparation and administration.

Knowledge of federal and state regulations that impact healthcare and other employee benefits programs.

Knowledge of computerized financial management systems.

Knowledge of statistical and analytical evaluation techniques.

Knowledge of auditing techniques and procedures.

Skilled in use of computer and business applications.

Skilled in both verbal and written communications.

Ability to develop comprehensive reports and presentations.

Ability to effectively communicate, both verbally and in written form.

Ability to analyze and interpret financial and statistical data.

Ability to apply knowledge and skills in a collaborative setting.

Ability to establish and maintain effective working relationships.

Ability to serve as project manager for major/special projects.

Ability to supervise the work of others.

Ability to analyze, develop, and implement operational procedures.

ADDITIONAL QUALIFICATIONS FOR PROMOTION: N/A.