Managed Care Analyst - Capitation Revenue

About the role

The Managed Care Analyst advances MemorialCare’s Managed Care Contracting and Operational strategies through financial analysis, contract modeling, and advisory support. This role reports to the Manager of Managed Care Analytics and supports all MHS entities: Hospitals, Foundation, IPA, and Health Plan. The position supports the Managed Care strategy by assembling and analyzing financial data for routine reports from sources including Snowflake, payor capitation data, cost accounting system data, GL, budgeting, and patient billing data. The Analyst evaluates complex commercial and government payer arrangements, including ACOs, Direct to Employer, Medicare Advantage, Medi-Cal, medical group, and ambulatory contracts.

The Analyst will attain competency with Snowflake, SQL, accounting systems, and EPIC to analyze data and trends.

Responsibilities

• Provide financial analysis and ad hoc reporting to internal stakeholders and leaders.
• Collaborate with senior team members and cross-functional departments to design and run queries and reports based on external reporting requests, ensuring data integrity, accuracy, and timeliness.
• Model specific reimbursement terms to support the Managed Care negotiation team, including MCMF, MHS, and MCSHP.
• Develop and maintain reporting templates to measure performance of health plan trend and yield, and proactively report out on a monthly basis.
• Support monthly financial close by proactively identifying trends, outliers, requested reports, and answering inquiries.
• Complete and distribute monthly reporting packages to internal stakeholders.
• Apply strong analytical and problem-solving skills to evaluate complex data and business issues, leveraging both conventional and innovative approaches.
• Work with minimal supervision, take ownership of assigned analyses, deliverables, and issue resolution.

Requirements

• 2 years of experience, preferably in a Managed Care analytic setting.
• Proficient in SQL development and Epic systems, with advanced Excel capabilities and strong command of Microsoft Office tools.
• Extremely organized with a strong sense of priority, urgency, and commitment to deadlines.
• Self-motivated individual able to handle fluctuating volumes of work and prioritize to meet deadlines.

Qualifications

Bachelor’s degree in Business, Finance, or Healthcare, required.

Pay

Pay range: $41.09/hr - $51.56/hr. Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including shift differentials, extra shift incentives, and bonus opportunities.

Benefits

MemorialCare offers high-quality health insurance plan options, allowing you to select the best choice for your family. Additional benefits include wellness programs and rewards. Check out our MemorialCare Benefits for more information.

Schedule

Full-Time, Days (8-hour shift).

Location: Fountain Valley, CA / Predominately Remote (Must be located in CA).