Financial Business Analyst
Detroit, MI US
Under the direction of manager, the Principal Financial Business Data Analyst is responsible for completing comprehensive, quantitative, and financial analysis related to reporting Government program revenue. This position will be responsible for building and maintaining a data model to efficiently produce automated reports to meet HAP’ s revenue reporting needs. The position will provide expertise in utilizing internal and external data, creating automated reporting processes and procedures, writing analytical reports, and making recommendations for meeting reporting goals. The position will collaborate with data stewards and subject matter experts to ensure financial goals are met. The position will provide technical and analytical expertise to other internal departments. The position will assist in presenting to and advising upper management and/or key stakeholders on forecasted plan revenue and recommended solutions for project valuation and risk score impact on revenue. The position will serve as a subject matter expert in Accounting and Finance of CMS HCC Risk Adjustment and its role in managing CMS revenue.
DUTIES AND RESPONSIBILITIES:
· Under the direction of Manager, utilize internal and external data sources to design, implement and maintain data model for monthly accounting cycle reporting of government program anticipated revenue, annual reporting of Medical Loss Ratios, MLR, annual Accounting of subsidized pharmacy program funds, as related to Medicare Advantage part C, D and Medicare-Medicaid Program.
· Monitor, interpret, disseminate information and implement changes, as applicable to Medicare program, per CMS and/or State on-going communications to health plans specific to the financial analyst role.
· Design, implement appropriate process and control mechanisms to ensure that data model and table updates are complete and accurate.
· Utilize data sets and financial acumen to estimate the impact on revenue accruals for financial reporting and to report risk scores. Prepares and delivers well-organized reports to reflect risk adjustment project valuation, and basis for recommendations to revenue accruals, and analytic methods to determine such findings.
· Primary user of HCC Risk Adjustment vendor application. Monitor vendor system for assessment 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.
· Design processes to produce automated reports at several cut points required within the organization (Contract, Benefit Plan, Provider Organizations, Group)
· Support leadership in the development and implementation of strategic financial initiatives, product offerings, and other strategic business programs through the extraction, analysis and summarization of appropriate data sets and benchmarks. Support to such projects include but are not limited to annual bid preparation, employer group rate renewals, financial reporting for corporate initiatives.
· Coordinate with leadership and multiple departments within the organization, including but not limited to Actuarial Services, Underwriting, Financial Analysis, Financial Services, Risk Adjustment, IT-Business Intelligence, Provider Services, Network Management, Data Analytics, Revenue Cycle for expertise in government programs, payment methods, revenue attribution, and risk adjustment.
· Design, implement appropriate processes and control mechanisms to ensure that generated reports reconcile to general ledger. Maintain all documentation for reported accruals to adhere to Financial Audit requirements and future reconciliation with CMS Payment.
· Coordinate and communicate functional requirements of business unit and technical solutions with IT capability resources by designing and documenting functional specifications. Develop and maintain policies and procedures specific to government revenue and risk score reporting.
· Representation on various corporate sub-committees and workgroups ensuring government program revenue and Risk Adjustment reporting needs are met when upgrades/changes are made to Company or Vendor’ s systems or processes. Subject matter expert contributing to development and tracking of internal dashboards and key performance indicators.
· Coordinate technical modifications with internal teams (IT-Business Intelligence, Risk Adjustment, etc.) and Vendor such as data extraction and table updates to correct configuration issues affecting monthly reporting processes as required.
· Utilize CMS government program regulatory communications and knowledge and understanding of Risk Adjustment program operations, Risk Adjustment payment methods, HCC-Coding, to assess impact on government program financial reporting.
· Identify and drive continuous improvement initiatives that improve the efficiency and effectiveness of reports and reporting processes.
· Perform other duties as assigned.
· Bachelor’s degree in Computer Information Systems, Statistics, Business, Accounting, Finance, Health Care Services Management, or other technical and quantitative focus.
· Minimum of five (5) years of progressive analytical experience in healthcare data or managed care operations preferably in Medicare programs; specific to revenue, payment methods, and HCC risk adjustment principles
· Minimum three (3) years’ experience with data interpretation, statistical analysis, and reporting; claims, clinical and financial data; budgeting and forecasting; trend analysis.
· Advanced knowledge of Accounting and Finance principles to conduct input for regulatory state and federal reporting, operational planning, controls and budgets for development of operational strategies, objectives and goals
Minimum three (3) years of experience with Information Technology including programming language SQL in Oracle or Microsoft Developer Studio, Accounting applications, and MS office Excel.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities and duties of personnel so classified.