Financial Analyst

Reference Code: 8095

Position: Financial Analyst
Duration: 7 month contract with possible extensions
Location: Remote

Key Responsibilities/Deliverables:

•  Primary user of Risk Adjustment vendor application. Monitor vendor system for assessment of RAPS and EDPS data submission / acceptance status, progress of risk projects, utilization of Vendor supplemental data to assist in risk adjustment project pricing, ongoing assessment of data integrity and completeness issues that may impact risk adjustment project valuation.  

• Utilize CMS government program regulatory communications and knowledge and understanding of Risk Adjustment program operations, Risk Adjustment payment methods, HCC-Coding models, to assess impact on government program financial reporting. 

• SME Liaison to multiple departments within the organization, including but not limited to Provider Services, Network Management, Actuarial Services, Underwriting, Financial Analysis, Financial Services, Risk Adjustment, IT-Business Intelligence, Data Analytics, Henry Ford Health System Revenue Cycle for expertise in government programs, payment methods, revenue attribution, and risk adjustment. 

• Maintenance of the following queries and analysis: Reconciliation reports for CMS MA Part C/D Risk Adjustment program receivables and payables for monthly accounting needs. Monitor accruals for final reconciliation with CMS. 

• Maintenance of the following queries and analysis: Reconciliation reports for CMS Part D Reinsurance, Low Income Cost Sharing, Risk Sharing program receivables and payables for monthly accounting needs. Monitor accruals for final reconciliation with CMS. 

• Develop and enhance reporting capabilities for financial and operational performance. 

• Support annual financial reporting activities including CMS bid filings, RFP on financial Risk Adjustment projects, Employer Group Rate Renewals, financial audits, CMS Attestations, Medical Loss Ratio annual filing requirements, CMS premium, risk adjustment, member and provider revenue budgets. 

• Analyze department reports to identify data integrity issues, system and programming problems, and work with management to develop and implement improvement solutions. 

• Assist department in performing routine assignments, ad-hoc projects and meeting established deadlines.  Engage assistance of departmental support analysts in completion of required responsibilities where appropriate. 

• Basic Accounting principles for Journal Entry preparation and Account reconciliation. 

• Perform other related duties as assigned. 

Required:

•   Four (4) years of Finance experience in Health Care Insurance or Managed Care Organization 

• Three (3) to five (5) years of experience developing, analyzing, interpreting & trending data 

• Three (3) years of experience with Medicare Advantage, Medicare Part D, Medicaid or Qualified Health Plans or Affordable Care Act 

• Strong understanding of Risk Score, CMS Risk Adjustment HCC and RxHCC models, RAPS/EDPS data, and impact on premiums in government programs 

• Proficient knowledge of MS Office products Advanced Access, Advanced Excel, Power Point, and Word 

• Experience in health care finance, claims processing, and Medicare and Medicare/Medicaid program payment methods 

• Accounting and finance principles as they relate to revenue payments, claims, and membership data, financial projections, variance analysis 

To submit your application, click on the 'Apply for Job' link below 

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