PBM Operational Finance Specialist

The Senior Financial Specialist, PBM Operations will assist the senior manager in driving an accurate and efficient Month-End Close for assigned responsibilities and serves as a subject matter expert in Medicare Part D financial operations. This position is responsible for managing financial reconciliations, implementing financial controls, forecasting, reporting, and overseeing CMS and client payments for the Medicare Part D EGWP product and Medicare Part D health plan clients.

The primary operational responsibilities are focused on Medicare Part D EGWP Finance operations. In addition, operational accountabilities include financial processes that span all Medicare clients, including but not limited to Direct and Indirect Remuneration (DIR) support, administrative fee support, new Inflation Reduction Act billing & collection support,

In addition to their daily operational responsibilities, the Senior Finance Specialist assists the SVP of PBM operations in coordinating the daily financial needs of the PBM division by being the first point of contact for questions between the PBM operations team and the Finance. Provides guidance, training, and status communications to peers and other Finance team members; performs as project lead or subject matter expert on finance team projects. Senior Finance Specialists are responsible for answering team questions through the engagement of the Senior Premium Account Manager. This position is also responsible for communicating those answers and other communications to their assigned teams.

DETAILED RESPONSIBILITIES

• Execute daily financial transactions and procedures while ensuring compliance with Company policy and technical and regulatory body requirements. Stay current on the company's technical accounting and finance approach and positions.
• Develops, coordinates, oversees, and reports the status of the monthly financial close cycle. Maintains and adjusts the cycle as necessary to meet or accelerate deadlines.
• Responsible for developing monthly and quarterly cash flow reporting and analysis, coordinating requirements, and having a visible role in meetings, ensuring clear communication of cash flow needs, opportunities, and risks.
• Prepares timely, accurate, and complete financial close reporting, projections, analyses, and explanations for senior management and GST Finance as needed.
• Responsible for overseeing new PBM client invoicing implementation process for Finance.
• Oversight of the accounting impacts. This includes reviewing and approving monthly journal entries, account reconciliations, and analysis of results for financial activity within PBM Accounting.
• Oversees completion of all close cycle components and executes the more complex components (e.g., liability estimates, write-off recommendations, complex journal entries, etc.).
• Reconciles drug manufacturer reimbursements to the employer group and manages the group-level reporting and payments.
• Generates accrual reports and performs ad hoc analyses in response to client requests for CMS subsidy impacts on client benefit designs and performance.
• Oversees cash receipts and distributions and administers CMS overpayment processes.
• Monitors client performance related to CMS subsidies. Forecasts EGWP client subsidies as required.
• Develops and maintains deep subject matter expertise related to Medicare Part D Payment processing, Medicare Part D benefit administration, and related financial functions.
• Support and manage requests from internal and external auditors as they complete the financial statement and internal control audits.
• Reviews peers' work, including journal entries, reconciliations, and economic and operational reports, for accuracy and completeness.
• Evaluate and propose process improvement and efficiency opportunities.
• Performs and/or ensures the completion of other operational duties, such as reviewing new contracts for PBM Finance deliverables and responsibilities.
• Assess and improve internal controls and policies/procedures to address the current operating environment, including touch points with other departments and operating entities, and introduce best practices.
• Report and resolve internal and external stakeholder issues or inefficiencies. What does this mean?
• Foster strong inter-departmental collaboration on projects, initiatives, and problem resolutions.
• Participate in industry and technical seminars/training; maintain and acquire additional certifications and skills; establish professional and personal networks; research best practices and knowledge share with others; participate in professional or industry societies.

• BS or MS degree in Accounting, Finance, or Audit
• 5-7 years of accounting, auditing, or finance operations experience within the PBM/RX industry highly desired
• At least 3 years' PBM (Pharmacy Benefit Management) experience.
• At least 3 years of experience reviewing the work of others and mentoring/coaching or supervisory experience.
• Relevant industry accounting experience (e.g., RX/PBM operations, insurance/group benefits, third party administration, revenue recognition, etc.) with a broad range of accounting and financial analysis exposure highly desired
• The ideal candidate will have a strong accounting background with the ability to meet tight deadlines in a fast-paced environment.
• Ability to work cross-functionally in a large organization, communicating effectively at all levels.

• Strong data analysis and related analytical tool skills (Access, Excel)
• Experience with Great Plains or similar G/L packages
• Ability and experience with system and data conversions
• Ability to converse knowledgeably with IT personnel.
• Advanced skills in Microsoft Office products with an emphasis on Excel, Word, and Power BI

• Ethics, integrity, high-quality service delivery
• Entrepreneurial, self-sufficient, proactive with recommendations and actions
• Internal and external customer service
• Relationship-building, teamwork, mentoring, networking

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