Senior Healthcare Financial Analyst
- Career Level
- Experienced (Non-Manager)
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full-time Senior Healthcare Financial Analyst to perform and present the results of various health care data analysis which will be used to guide business decisions and strategies.
The essential duties & responsibilities will include the following:
•Develop and prepare decision support tools to advise HPSM on activities related to medical cost trends,utilization of medical services, and provider contracting and reimbursement.
•Complete analysis of high cost drivers of medical costs and identify the root causes of the underlyingunit cost and utilization trends.
•Assist in provider contracting efforts by determining the financial implications of changes to providerreimbursement rates or methodologies.
•Estimate the costs of new products, programs, and policies.
•In collaboration with other departments, develop solutions to address financial trends and establishmonitoring systems to determine the effectiveness of changes made.
•Prepare executive reports and dashboards on medical cost performance and trends.
•Calculate monthly reserves required for IBNR and present monthly IBNR analysis and recommendationsto management.
•Complete required governmental reporting, including rate development worksheets for Medi-Cal,Medicare bids, State health care cost reconciliations and CMS annual MLR filings.
•Perform other duties as assigned.
Education and Experience: Bachelor’s degree in Medical Economics, Finance, Statistics, Actuarial, or a health-related field of study. Minimum five (5) years of financial and health care data analysis experience, preferably in a health plan or IPA/medical group environment.
Knowledge of: Complex health care data analyses. Methods of report preparation, writing and presentation. Statistical research, analysis and techniques. Healthcare industry data reporting standards, terminology, and guidelines. Medi-Cal and Medicare claims billing policies and procedure codes. Personal computers with a proficiency in database management and Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint. Knowledge of SQL and Visual Basic highly preferred. Principles and practices of financial management.
Ability to: Work with relational database concepts and applications. Analyze and evaluate a variety of complex financial issues and recommend effective solutions. Apply critical thinking and problem solving skills to complex analyses. Interact and work effectively with other departments and management. Achieve high degree of accuracy on all reports and analysis and possess excellent attention to detail. Work with minimal supervision while managing multiple tasks and meeting established deadlines. Possess strong written and oral communication skills. Present data in a clear and understandable manner. Good organization skills to work on multiple assignments simultaneously, prioritize work, and complete projects
Compensation & Benefits
Starting Compensation Range: - depending on experience. Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, STD, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.
Submissions without a Cover Letter and salary expectations may not be considered.
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