Healthcare Financial Analyst III

Job Summary

The Healthcare Financial Analyst III will lead the extraction and compilation of various sources of information and large data set to support the production of internal and external routine healthcare reports and complex ad hoc studies. The Analyst III will create reports and analyze studies for all LOBs (Medi-Cal, Medicare, and Commercial) to identify key drivers of performance and offer recommendation to improve performance. Provide and present executive summary of findings. This position participates in process improvement and procedures to ensure the department maintains in compliance.

Responsibilities include generate data to feed regulatory request required by Department of Health Care Services (DHCS) such as Rate Development Template, Supplemental Data Request, Audit Request. Work collaboratively with manager, the Actuarial and Finance team as well as other departments to summarize financial data and provide robust reporting and observations regarding key performance drivers.

This position will work closely with members of management to ensure new systems and procedures are implemented smoothly. This position support request from Centers for Medicare and Medicaid Services(CMS), Plan Partners, contracted providers, County of Los Angeles, and other revenue or payment sources; Legal services support; other support of the Manager, Data Analysis and Actuarial Reporting as directed. Interfaces and serves as liaison with multiple internal and external departments. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.

Duties

Generate data to feed regulatory request required by Department of Health Care Services (DHCS) such as Rate Development Template, Supplemental Data Request, Audit Request. Oversee documentation of data source, process and calculation method for audit trail purpose. Accurately and timely completion of regulatory data request.

Develop and analyze ad hoc and routine monthly/quarterly/yearly reports, identify and research significant variances, lead and provide advance analytical support to determine root cause and drivers, turn data into information.

Create integrated revenue/medical care expense (FFS + RX Claims/Provider Capitation/other medical cost) analysis, perform financial reconciliation and data validation.

Perform provider contract analysis. May support accounting software upgrade and finance data project.

Partners with key stakeholders to foster strong working relationships. Collaborates with team regarding Actuarial analysis needs and system updates. Identifies and recommends process improvement.

Oversees auditing of actuarial practices procedures and data to ensure accuracy of information and ease of providing information to meet deadlines.

Manages special projects, engaging key external and internal stakeholders, obtaining buy in and consensus, costing, obtaining approvals, communicating and implementation of project outcomes.

Participates in the development of training materials pertaining to Actuarial/Financial process and procedures. As a Subject Matter Expert, Analyst III provide guidance on programming/logic improvement, conduct training, and act as a mentor to Analyst I and II. Perform peer review. Meets deadlines with accurate data and support the legal department's arguments.

Perform other duties as assigned.

Education Required

Education Preferred

Experience

Required:
At least 5 years of finance or managed healthcare experience.

Minimum of 4 years experience of Medi-Cal/Medicare/Commercial medical claims, summarize cost and calculate service utilizations. Able to extract claims based on medical codes such as Diagnosis Related Group (DRG), Revenue Code, Current Procedural Terminology (CPT), International Classification of Diseases (ICD), ..etc.

Skills

Required:
Understanding of financial/accounting concepts.

Strong Analytical programming skill (e.g. SQL, Oracle, or other Business Intelligence tools).

Must be able to create and manage complex Excel spreadsheets.

Demonstrated proficiency in data analysis, MS Excel, and SQL programming.

Must have solid and effective verbal, written and interpersonal communication skills.

Must have strong analytical and problem solving skills.

Knowledge of health care cost structures (fee schedules, health care cost categories, and health care service utilizations, and medical codes).

Ability to work in a fast-paced environment, with frequently shifting projects and priorities.

Strong health Care industry, health plan, providers knowledge.

Preferred:
Working knowledge of capitated encounters.

Ability to abide by L.A. Care policies.

Ability to establish and maintain positive and effective work relationships with coworkers, staff and management.

Ability to work independently and as a team player.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Additional Information