Your Role
The Managed Care Finance team administers the financial terms and conditions of our capitated contracts with IPA/Medical Groups, Hospitals, and Vendors. The Financial Analyst, Experienced will report to the Manager of Managed Care Finance. In this role you will be performing provider contract analysis, financial research, preparing financial forecasts, analyzing data trends, and translating data into useful information. You will interact with a variety of internal units as well as IPA/Medical Groups to monitor financial payments and reporting to ensure compliance with contractual requirements and governmental regulations.Your Work
In this role, you will:
Analyze limited raw revenue/expense data and summarize detailed revenue/expense data; compare summarized claim data against fee schedules and contractsAssist with production of contract performance reports, modeling of reimbursement rates, evaluation of financial contract modifications and compiling and monitoring key managed care statisticsParticipate in the development of financial models; collect and evaluate data, analyze resultsPerform daily cash desk activities (e.g., account review, funds movement, daily reporting, near-term forecasting)Follow and conduct audit processes and review internal controls to ensure financial transactions are accurate, timely and comply with accounting standards, principles and company policyGenerate reporting and provide analysis of capitation, eligibility, membership, shared risk arrangements, claims, and provider incentive programsDevelop financial accruals and prepare payments for expenses related to retroactive capitation rate increases, shared risk settlements, provider incentives, provider claims, and other non-standard contract provisionsProvide contract interpretation consultation (including non-standard contracts) to internal business units and external provider customersAssist in the development of new processes and reporting mechanisms to meet company needs and improve customer serviceAddress and/or resolve non-standard customer issues and builds strong relationships with customersYour Knowledge and Experience
Requires a bachelor's degree or equivalent experienceRequires at least 3 years of prior relevant experienceExposure to health care related membership, capitation, claims processing systems, and/or provider contracting is desiredKnowledge of the functions and responsibilities of other units within a health insurance company and familiarity with the health insurance industry is desiredRequires the ability to use computers and related software applications including MS Access and/or ExcelAbility to debug, modify, and enhance existing Access databases and Excel macros and develop new applications in MS Access and/or Excel for automated processes and data manipulation is desiredRequires the ability to read, analyze and interpret non-standard provider contracts, technical procedures, and governmental regulations