This position will be responsible for guiding AltaMed financial strategies including the development and execution of financial planning models and analysis across all major lines of business. This role encompasses the preparation of financial plans and forecasts, analyses of financial and operational results, and investigation of significant variances. Specifically, the position will provide financial and business decision support to derive the optimum risk sharing, pricing strategies, contract language, and customer profitability for managed care contracts as well as partner with the senior management team to develop contracting strategies and operating policies for all the major AltaMed books of business. Additionally, this position will develop and direct complex risk, pricing, and profitability models to evaluate strategic mergers and acquisitions, new facility development, new contracts and business development, and other related business planning. This position will support key business decisions by providing guidance on underlying assumptions, conducting due diligence, participating in the planning process, interpreting results, and making recommendations to senior management on methods to improve market share, service expansion, contract profitability, cash flow, and return on investment.Responsibilities
Monitor major payer performance through a variety of metrics. Analyze, interpret, and trend payer performance.
Review and analyze premium rates for appropriateness and develop analysis and arguments to support negotiations.
Monitor risk adjustment factors applied to rates and evaluate financial impact.
Review and analyze monthly claims reserves (Incurred But Not Reported) estimates for accuracy. Assist Finance Department and/or actuaries in setting monthly claims reserves.
Review and interpret contract financial performance with management and identify and implement responses to budget variances.
Prepare reports for and Manage relationships with State departments of insurance and other regulators for all financial matters ensuring compliance with regulations.
Develop annual budget for managed care division.
Reconcile premium receipts to eligibility
Review and analyze provider contract financial terms and recommend changes. Develop scenario modeling and identify savings opportunities.
Represent finance function by participating in committees or work groups and multidisciplinary teams as necessary.
Oversee insured services, overpayment recovery, and risk pool claims audits.
Develop and maintain reporting systems for maximization of annual managed care revenue, including the negotiation of pay-for-performance initiatives, risk sharing and other gain-sharing opportunities with payers.
Design and evaluate Primary Care Provider incentives to encourage appropriate resource use.
Interact extensively with senior and the managed care management team; identifying financial performance, related to gross margins, unit costs, utilization metrics, etc. for contracted provider networks at the individual provider level to support contracting strategies, plans and monitoring.
Actively participate in the development of AltaMed business strategy consistent with the organization s financial goals.
Prepare financial modeling for new business development, cost saving projects, capital expenditure evaluation, and product line profitability.
Perform due diligence and internal valuation for proposed physician practices or IPA acquisitions.
Supervise the Financial Analysts and others as assigned.
Perform all other related duties as assigned.
- B.S. degree Business, Finance, or Accounting coupled with a minimum of 10 years of accounting and finance experience with at least 7 years of comprehensive knowledge of managed care, prescription drug benefits, and pharmaceutical contracting principles and with four years of progressively responsible management experience required. An MBA is highly desirable. CPA is preferred.
Associated topics: actuarial, actuary consultant, assistant actuary, investment actuary, life actuary, mathmatics, model, probability, retirement actuary, statistics
• Post ID: 138335917 losangeles