This position will analyze financial and health information to develop insights that support business decision making related to healthcare revenue, cost, and clinical outcomes by mining, extracting and utilizing appropriate data from the data warehouse, data marts/cubes, and various internal source systems on a regular and ad-hoc basis specifically within the managed care industry. The position will prepare and complete all aspects of Managed Care reporting including, but not limited to, auditing capitation revenue; Primary Care Provider (PCP) and specialty cap; preparing risk pool and incentive summaries and analysis; designing capitation models by health plans; preparing managed care annual budgets and attending stakeholder meetings; and identifying revenue capture opportunities. Additionally, this position will compile financial analysis and other reporting on a recurring and/or as needed basis relevant to healthcare, utilization and financial management for AltaMed IPA.
- Identify revenue capture opportunities by analyzing current process, utilizing data warehouse and other internal source data systems to automate the process for recovery unit to collect payments, such as claims overpayment, leakage claims and billable services.
- Develop tools for monitoring the accuracy of PCP and Specialty cap payments to ensure consistency with contracted rates and member eligibility.
- Complete extensive and complex financial and operational analyses of managed care contracts and proposals.
- Work with management to understand the business needs. Interpret the business needs into business rules and data elements. Document and assemble requirements to generate reports, charts, scorecards, dashboard, forecast for stakeholders.
- Develop and track business key performance indicators.
- Produce and present deep dive analyses to facilitate understanding of Medical Cost levels and trends and facilitate strategy development.
- Audit and analyze all health plan capitation payments and other related revenues to ensure the rates/payments are in accordance with the health plan contracts.
- Compare and analyze capitation yield to the budget. Provide for monthly reporting of results obtained from audits and variance analysis.
- Perform risk pool auditing and analysis, including review of utilization data impacting risk pool performance.
- Annually, research, analyze historical revenue and cost data to project budget for the next fiscal year.
- Produce monthly financial statement by region by line of business and compare it to the budget.
- Generate monthly claims analysis to identify high-cost specialties. Provide trend for claims age and payment turnaround time.
- Conduct financial and clinical analysis related to all aspects of the AltaMed IPA and managed care.
- Perform monthly Capitation Reconciliation, risk pool and incentive reconciliation, etc.
- Develop ad-hoc and ongoing reports as necessary to support business unit needs. Perform special analysis on utilization and/or cost reports.
- Perform all other related duties as assigned.
- Bachelor s degree in accounting, finance or business or other related areas required. A Master s degree preferred.
- At least five years in financial analysis and database reporting in the health care or managed care industry required.
- Experience with database and data analysis technology. Microsoft Access is a must. EZ Cap, Cap Check, Cognos and Crystal Reports experience highly desirable.
Associated topics: analysis, business finance, consult, examiner, financial analyst, financial analytic, forecasting, market, strategy, valuation analyst
• Post ID: 136132718 losangeles