The DHPCO’s Bureau of Managed Care Fiscal is responsible for reviewing and analyzing Managed Care Organizations financial solvency and overall compliance with financial rules and requirements. The staff is charged with developing, disseminating and analyzing Medicaid Managed Care Operating Reports (MMCORs) and ensuring that Managed Care Organizations (MCO’s) meet mandated fiscal, regulatory and policy compliance standards and submit cost reports, medical loss ratio (MLR) reports and any other financial information, as necessary and in accordance with regulatory and statutory requirements. The Burau is also responsible for financial, solvency and reasonableness review and approval of MCO-provider and management contracts.
The main duties of Auditors within the Fiscal Oversight Unit would include but be not limited to:
• Overseeing timely filing and accuracy of the quarterly and annual financial reporting for
assigned Medicaid managed care line of business.
• Review and analysis of Medicaid Managed Care Operating Reports (MMCORs), Medical
Loss Ratio (MLR), Annual Certified Audited Financial Statements and NYS Escrow Fund
bank statements submitted by managed care plans.
• Reviewing and evaluating equity transfers, such as dividend requests, asset transfers
and surplus note repayments.
• Evaluating plan contracts and contracted vendors for compliance with fiscal solvency
• Monitoring the financial condition of assigned MCOs, including analysis of their financial
operations and compliance with financial reporting such as, the Contingent Reserve and
Net Worth requirements as mandated by Public Health Law, regulations, and policies.
• Draft reports and memoranda to communicate findings and work with both internal
counterparts and assigned MCOs to improve compliance in all areas of fiscal reporting and data submission.
• Assist with special projects as assigned.
• Maintain a positive, professional demeanor.
• All other activities as may be deemed necessary.
• College Degree in Accounting, Business Administration or equivalent preferred.
• Consideration for High school graduate with appropriate experience in accounting,
accounts payables/ receivables
• Knowledge of Accounting principles and practice.
• Ability to review financial statements, balance sheets, profit, and loss statements.
• Proficient in the use of standard office technology i.e., Microsoft Word and Excel.
• Ability to be flexible, innovative, and work in a team environment.