Finance and Operations Manager – WVCHIP 5,000 Incentive

Nature of Work

**Selected candidates who agree to work for a minimum of twelve (12) months may be eligible to receive a $5,000 appointment incentive. This incentive does not apply to current employees of the State of WV. **

Under the limited supervision of the Deputy Commissioner for West Virginia Children's Health Insurance Program (WVCHIP), this position oversees the operational and financial processes of the Children's Health Insurance Agency, which administers the statewide Children's Health Insurance Program (CHIP). The program operates with a $77 million budget and serves over 40,000 children annually.

Key responsibilities include strategic and administrative budgeting, management of complex benefit delivery systems (including managed care and fee-for-service models), and oversight of financial reporting and revenue collections to ensure compliance with federal requirements.

This position:

• Develops budgets based on the broader operating environment, including state and federal regulations and market trends.
• Assists in drafting State Plan Amendment language to secure federal funding through the Centers for Medicare and Medicaid Services (CMS).
• Prepares annual state allotment requests and fiscal notes for pending legislation.
• Monitors program expenditures and spending authority to ensure sufficient funding throughout the fiscal year.

Conducts financial research and data analysis to support the development of new CHIP policies. Provides detailed reports and memoranda on proposed changes to benefits, enrollment structures, or initiatives that may impact program finances. Evaluates their effects on CHIP's annual budget and the Children's Health Trust Fund to ensure compliance with applicable laws and regulations.

Serves as liaison with the Agency's Actuary to:

• Develop expense projections
• Prepare quarterly reports
• Review actuarial findings
• Estimate incurred but not reported (IBNR) claims for state and federal reporting

Collaborates in developing managed care capitation rates and advises fiscal agents and managed care organizations to ensure correct implementation of benefits and claims payments per federal and state regulations.

Supports updates to fee schedules, including prospective payment rates for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), and addresses provider reimbursement or encounter claim issues with managed care organizations.

Provides assistance to the Deputy Commissioner in budgeting and reporting functions, working collaboratively with various partners to support CHIP's continued operational and fiscal success.

Performs Other Related Duties As Required.

Minimum Qualifications:

Training:
Bachelor's degree from an accredited college or university with at least 24 semester hours in accounting.

AND

Experience:
Four (4) years of full-time or equivalent part-time paid experience in professional accounting, statutory accounting, auditing work, forensic accounting, public accounting, investigative and/or forensic auditing, certified fraud examining, or other directly related accounting.

OR

Substitutions:
(1) Master's degree in accounting may substitute for two (2) years of the required experience. (2) Certification or registration as a Public Accountant in West Virginia may be substituted for the training and two (2) years of the required experience.

Other Information:

Preference will be given to applicants holding a Certified Fraud Examiner (CFE), Certified Forensic Accountant (CFA), Certified Valuation Analyst (CVA), or applicants who have completed a graduate certificate program in forensic accounting and fraud investigation.

Approved Substitution:
An additional one (1) year of experience in accounting, auditing, bookkeeping, and/or finance may substitute for the required accounting semester hours at the rate of one (1) year of experience for every thirty semester hours.