Senior Health Care Financial Analyst

General Description Of Position

The Senior Health Financial Analyst is responsible for performing finance responsibilities and analyzing a variety of health plan data. The incumbent aggregates large datasets, carries out functions in databases, and performs business and financial calculations.

Essential Duties And Responsibilities

• Responsible for revenue and cost reconciliation activities using capitation invoices, eligibility files, claims and expense data and other relevant reports.
• Design and prepare reports that analyze the financial outcome of programs and make recommendations based on that analysis.
• Understand and track applicable regulatory and reporting requirements.
• Prepare reports required by regulatory agencies and ensure compliance with reporting requirements.
• Ensure accuracy and regulatory compliance for all materials or documents.
• Develop executive level reporting summarizing the financial, utilization and operational impacts of organizational initiatives.
• Analyze data to generate dashboard metrics and reports at required intervals (e.g., monthly/quarterly) for senior management, including medical loss ratios, medical costs, medical trends, and provider profiles.
• Use database skills to create queries, reports, and other output to produce analytics to support SCFHP’s business needs (e.g., financial, medical management, contracting).
• Retrieve and compile information, databases, and/or reports from internal and external sources.
• Support HEDIS and medical management analytical and reporting needs.
• Collaborate with Information Technology to validate report portal and data marts.
• Collaborate with Information Technology to provide encounter data reconciliation between regulatory agencies and health plan claims detail to ensure accurate and complete data.
• Support organizational needs by performing complex analyses on a wide range of organizational data; investigate and uncover root causes, identify trends, and propose solutions.
• Ensure understanding of customer needs by proactively clarifying scope and requirements and keep customers apprised of project status through effective communication.
• Create and maintain documentation for all reporting and analyses.
• Perform other related duties as required or assigned.

REQUIREMENTS

• Bachelor's Degree in Accounting, Finance, Business Administration, or related field; or equivalent experience, training, or coursework.
• Minimum three years of experience with the duties and responsibilities described above in health care.
• Superior analytical and qualitative skills and the ability to deal with complex problems/issues and large data sets.
• Relational database skills using various database tools.
• Strong working knowledge and proficient with Microsoft Office applications, particularly Access, Excel, PowerPoint, and Word.
• Knowledge of health care delivery and financing, especially with public programs.
• Strong oral and written communication skills, including the ability to express oneself clearly and concisely; and the ability to effectively interact with and present findings to customers at all levels of the organization.
• Ability to gather and analyze a wide variety of data, organize and write reports, and organize work efficiently.
• Ability to achieve high quality deliverables by assuring accuracy and thoroughness in executing projects.
• Able to understand, interpret, and apply applicable rules, regulations, and establish and evaluate priorities.
• Self-directed with proven ability to assume responsibility, work independently, meet deadlines, prioritize, and move projects/deliverables to completion with accuracy and minimum supervision.
• Able to take initiative and exercise good judgment when making decisions within the scope of the position.
• Able to think and work effectively under pressure and under ambiguity.
• Able to maintain confidentiality.
• Able to comply with all SCFHP policies and procedures.
• Able to perform the job safely with respect to others, to property, and to individual safety.
• Prior experience in a managed care business environment, particularly with Medi-Cal, Medicare Advantage or Medicare Prescription Drug programs.
• Experience using SQL, SAS, or other database applications, including skills in SQL to enhance data manipulation/analysis.