Senior Financial Analyst, Medicare Finance Operations - Platinum Resource Group

Senior Financial Analyst, Medicare Finance Operations

Location; Huntington Beach, CA (Hybrid)

JOB DESCRIPTION

The Senior Financial Analyst – Medicare Finance Operations (MFO) is responsible for designing, reporting, and analyzing income statements by medical group, assuring accurate payment of capitation, and risk pool reporting and periodic payments. Also supports the analysis of membership, revenue and healthcare costs including support for budgeting/forecasting, CMS bid process, medical expense analysis, contracting support, and Part C and Part D reporting.

• Assist in the development of Provider Management Report (PMR) and financial models to track profitability by medical group, by line of business, by product line, by Plan Benefit Package (PBP), by region, by risk type, and by member type (dual-eligible vs. non-dual eligible).
• Analyze the financial performance of contracted medical groups. Research and provide explanations for the factors (e.g. utilization, risk scores, rates, etc.) that drive financial performance.
• With thorough understanding of global, professional, and shared risk capitation terms, calculate monthly provider group capitation.  Calculate related capitation deducts and track the recovery process.
• Provide monthly reporting for membership, risk pool performance and Rx rebate estimation to the accounting team for recording during the month end close process.
• Support Network Management contracting initiatives with timely and comprehensive medical group, hospital, and ancillary contract analysis.
• Use available data mining tools to retrieve information from various sources. Organize the information collected into a readable format or report. Present the information in a concise and understandable manner to colleagues and management.
• Provide financial analysis support for contract negotiation, corporate budgeting and forecasting process.
• Provide data to support the annual CMS bid process. Specifically, assist in the development of Medicare Part A/B/D bids and reconciliation to the financial statements.
• Prepare reconciliations and supporting schedules for various financial audits.
• Maintain MMR database with thorough working knowledge of MMR layout and meaning of each MMR field. Reconcile monthly CMS payments.
• Prepare and submit reports (MLR, DIR, PDE, P2P, etc.) to CMS for various attestations.
• Partner with IT to automate processes and reports for efficiency.
• Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
• Contribute to team effort by accomplishing related results as needed.

QUALIFICATIONS

• Bachelor’s degree in accounting, finance, economics, MIS or related fields.
• MBA a plus.
• Five (5) plus years’ progressive experience in corporate finance, provider capitation, or Medicare Finance Operations at MAPD plan analyzing, interpreting, and forecasting data.
• Thorough working knowledge of developing SQL and VBA programs.
• Essential concepts on data modeling and multi-dimensional database.
• Health Plan or related healthcare experience strongly preferred.
• Advanced knowledge of financial modeling in Excel and SQL applications.
• Strong analytical abilities.
• Strong verbal and written communication skills.
• Ability to work under tight deadlines, manage multiple responsibilities and work independently with minimal amount of supervision required.

Platinum Resource Group is a professional level consulting firm, providing resources to Fortune 1000 client companies in the areas of technology, human resources, accounting, finance, business systems and supply chain, on a contract and interim basis. PRG has operations in Orange County, San Diego, Los Angeles, and San Francisco. As a W-2 employer we offer our consultants direct deposit bi-weekly payroll, health, dental, vision benefits, paid holidays, and referral bonuses.