- Responsible for revenue and cost reconciliation activities using capitation invoices, eligibility files, claims and expense data and other relevant reports.
- Design and prepare reports that analyze the financial outcome of programs and make recommendations based on that analysis.
- Understand and track applicable regulatory and reporting requirements.
- Prepare reports required by regulatory agencies and ensure compliance with reporting requirements. Ensure accuracy and regulatory compliance for all materials or documents.
- Develop executive level reporting summarizing the financial, utilization and operational impacts of organizational initiatives.
- Analyze data to generate dashboard metrics and reports at required intervals (e.g., monthly/quarterly) for senior management, including medical loss ratios, medical costs, medical trends, and provider profiles.
- Use database skills to create queries, reports, and other output to produce analytics to support SCFHP's business needs (e.g., financial, medical management, contracting).
- Retrieve and compile information, databases, and/or reports from internal and external sources.
- Support HEDIS and medical management analytical and reporting needs.
- Collaborate with Information Technology to validate report portal and data marts.
- Collaborate with Information Technology to provide encounter data reconciliation between regulatory agencies and health plan claims detail to ensure accurate and complete data.
- Support organizational needs by performing complex analyses on a wide range of organizational data; investigate and uncover root causes, identify trends, and propose solutions.
- Ensure understanding of customer needs by proactively clarifying scope and requirements and keep customers apprised of project status through effective communication.
- Perform data acquisition, data quality and validation, data analysis, data reporting, and present findings and recommendations to end users.
- Create and maintain documentation for all reporting and analyses.
- Perform other related duties as required or assigned.
- Bachelor's Degree in Accounting, Finance, Business Administration, or related field; or equivalent experience, training, or coursework. (R)
- Master's Degree in Accounting, Finance, Business Administration, Health Care Administration. (D)
- Minimum three years of experience with the duties and responsibilities described above in health care. (R)
- Superior analytical and qualitative skills and the ability to deal with complex problems/issues and large data sets. (R)
- Relational database skills using various database tools. (R)
- Strong working knowledge and proficient with Microsoft Office applications, particularly Access, Excel, PowerPoint, and Word. (R)
- Knowledge of health care delivery and financing, especially with public programs. (R)
- Strong oral and written communication skills, including the ability to express oneself clearly and concisely; and the ability to effectively interact with and present findings to customers at all levels of the organization. (R)
- Ability to gather and analyze a wide variety of data, organize and write reports, and organize work efficiently. (R)
- Ability to achieve high quality deliverables by assuring accuracy and thoroughness in executing projects.
- Ability to understand, interpret, and apply applicable rules, regulations, and establish and evaluate priorities. (R)
- Self-directed with proven ability to assume responsibility, work independently, meet deadlines, prioritize, and move projects/deliverables to completion with accuracy and minimum supervision. (R)
- Ability to take initiative and exercise good judgment when making decisions within the scope of the position. (R)
- Ability to think and work effectively under pressure and under ambiguity. (R)
- Ability to maintain confidentiality. (R)
- Ability to comply with all SCFHP policies and procedures. (R)
- Ability to perform the job safely with respect to others, to property, and to individual safety. (R)
- Prior experience in a managed care business environment, particularly with Medi-Cal, Medicare Advantage or Medicare Prescription Drug programs. (D)
- Prior experience and knowledge related to medical claims/utilization. (D)
- Experience using SQL, SAS, or other database applications, including skills in SQL to enhance data manipulation/analysis. (D)
- Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies; and sit or stand for extended periods of time. (R)
- Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds. (R)
- Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less. (R)
- Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment. (R)
- Hearing/
- Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person, by telephone, and electronically throughout a typical workday; attention to detail. (R)
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Senior Health Care Financial Analyst - San Jose, United States - Santaclara Family Health Plan
Description
FLSA Status:
Exempt
Department:
Finance
Reports To:
Director of Health Care Economics
GENERAL DESCRIPTION OF POSITION
The Senior Health Financial Analyst is responsible for performing finance responsibilities and analyzing a variety of health plan data. The incumbent aggregates large datasets, carries out functions in databases, and performs business and financial calculations.
ESSENTIAL DUTIES AND RESPONSIBILITIES
To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.
The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.
WORKING CONDITIONS
Generally, duties are primarily performed in an office environment while sitting or standing at a desk.
Incumbents are subject to regular contact with co-workers, managers, external partners, and vendors in person, by telephone and via work-related electronic communications.
PHYSICAL REQUIREMENTS
Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:
Talking Requirements:
ability to hear normal speech, hear and talk to exchange information in person and on telephone. (R)
ENVIRONMENTAL CONDITIONS
General office conditions. May be exposed to moderate noise levels.
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