Job Description

We are a non-profit County Organized Health System managing medical and support services for Medi-Cal eligible residents in San Mateo. We are seeking a full-time Healthcare Financial Analyst to perform routine and complex financial analysis and reporting to assist in the management of healthcare costs for all lines of business and to ensure adherence to reporting and reconciliation requirements with the State and CMS.

DUTIES & RESPONSIBILITIES

• Develop and prepare decision support tools to advise on activities related to forecasting, trend development, medical utilization, provider contracting, and State Capitation and reimbursement rates.
• Review claims payments for accuracy based on contract terms and Medi-Cal and Medicare guidelines.
• Calculate estimated costs of new products and programs and changes to provider reimbursement rates
• or methodologies.
• Review proposed capitation rates from the State for adequacy.
• Prepare monthly and quarterly overview reports on medical cost performance and trends.
• Complete analysis of high cost drivers to identify the underlying unit cost or utilization trends..
• Work with other departments to develop solutions and establish monitoring systems to determine the effectiveness of changes made.
• Prepare and present monthly IBNR analysis and reports.
• Complete required governmental reporting including rate development worksheets for Medi-Cal,
• Medicare bids, State health care cost reconciliations, and CMS annual MLR reporting.
• Assist in the development of health care budgets and forecasts.
• Conduct special analyses and projects at the direction of management for all lines of business as necessary
• Perform other duties as assigned.

REQUIREMENTS

• Bachelor’s degree in Economics, Finance, Accounting, or a related field.
• Minimum 5 years experience in healthcare financial analysis.
• Experience in Managed Care industry preferred.
• Knowledge of principles and practices of financial management and complex financial analyses.
• Experience with methods of report preparation, writing, and presentation.
• Experience with statistical research, analysis, and techniques.
• Knowledge of governmental regulatory requirements.
• Experience with healthcare industry data reporting standards, terminology, and guidelines.
• Knowledge of Medi- Cal and Medicare claims billing policies and procedure codes.
• Proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access, and PowerPoint.
• Ability to work with relational database concepts and applications.
• Analyze and evaluate a variety of complex issues and recommend effective solutions. Apply critical thinking and problem solving skills to complex analyses.
• Prepare clear and concise reports.
• Utilize computers and advanced computer software to analyze information. Communicate findings clearly and concisely in both a written format and in oral presentations.
• Communicate/Interact/work effectively with others.
• Achieve high degree of accuracy on all reports and analysis
• Possess excellent attention to detail.
• Work with minimal supervision while managing multiple tasks and meeting established deadlines.
• Understand key managed care functions and data complexities.

Powered by JazzHR

FUZQeXeBhy