Financial Analyst for Managed Care - Sinai Chicago

About Us:

At Sinai Chicago, we take health care personally. Excellence in health care is about more than just medicine, technology, tests and treatments, it is about really caring for people with dignity and respect. That’s what we do. We are dedicated to providing the best care to meet the needs of people, for our community, for our patients and for you.

Position Purpose:

Financial Analyst for Managed Care is responsible for analyzing and modeling managed care and population health risk agreements on behalf of Sinai Chicago Managed Care Department and Progress Health, Sinai Chicago’s, Clinically Integrated Network (CIN). Contractual arrangements include but are not limited to Medicaid, Commercial, Medicare Advantage, Medicare Accountable Care Organization (ACO) Reach, ACO – Medicaid, Capitation and global shared savings/risk. This role will partner with the Contracting team, CIN team and the Clinical teams on evaluating VBC shared savings/risk contracts, incentive programs and distribution, incentive funds flow, calculating and modeling projected financial risk performance (such as risk corridor scenarios, stoploss/reinsurance, feasibility, and scenario analyses). The analyst works with senior leadership to support future financial goals and strategies as well as modeling and forecasting. This role assists the Chief Population Health and Growth officer and team during risk-based contract negotiations to ensure successful contract negotiation and monitoring and enforcement of contract terms and support for value base care contracting initiatives. This role serves as a subject matter expert for risk-based contract terms developing monitoring tools and reporting to proactively manage and mitigate risk and improve contract performance. The analyst monitors and reviews existing and new Center for Medicare and Medicaid Innovation (CMMI) Government Programs whether for the hospital system, the ambulatory providers, or the CIN, to understand the risk components and partners with the Chief Population Health and Growth officer and interdisciplinary team to assess feasibility and requirements for participation. Additionally, this role collaborates with interdisciplinary teams across the care continuum – Decision Support, Financial Planning, Budgetary, etc. to support enterprise-wide alignment and reporting around VBC programs.

Key Job Activities:

• Performs sophisticated VBC risk analyses including developing contractual risk models, financial and operational models and performance monitoring and evaluations.

• Performs analyses for any managed care facility agreements. sinaichicago.org

• Works with Sinai Chicago Finance department in the preparation of the monthly CIN financial statements.

• Responsible for VBC and CIN risk corridor and feasibility analysis, financial forecasts of upside/downside risk, determination of Stop-Loss, among other risk-based contract terms.

• Creates financial models and forecasts that provide insight on mitigating potential losses and maximizing and optimizing financial performance under VBC contracts.

• Develops models for projecting and evaluating costs trends in risk contracts across enterprise.

• Supports development and maintenance of CIN incentive models and payout distribution methodologies.

• Utilizes all Sinai Chicago and/or payor data or data bases to perform analysis to assess changes and opportunities in total cost of care, leakage, and membership attribution.

• Works with interdisciplinary team on the development and monitoring of current internal performance and analysis of VBC risk contracts by creating standard internal reporting that monitors current performance and forecasts future trends.

• Partners with internal and external department analysts on developing physician incentive reporting, as well as custom reporting that analyzes data for trends analysis and interpreting medical patterns to uncover opportunities in risk performance. Supports subcommittee report outs on active risk-based programs.

• Continues education on ever-changing VBC program rules and policy updates both commercial and governmental that impact expected performance contract profiles and education of internal stakeholders on risk and performance terms, methodology, and impacts as needed.

Education and Work Experience:

• A bachelor’s degree in business, finance, healthcare, or related field, or a combination of relevant education and experience required. Advanced degree in a finance-based discipline is preferred.

• Five or more years of experience required with VBC and alternative payment models in either a multifacility health system or a payer.

• Five or more years’ experience required in multi-facility health system, large academic and community physician groups or clinically integrated network, large academic medical center, or insurer environment required.

• Medicaid experience highly preferred. • Safety net hospital experience highly preferred.

• Experience in risk programs analysis and reporting including Medicare Advantage, Bundled Payments, and ACOs highly preferred.

• Experience in supporting risk-based contract negotiations highly preferred.

• Experience with health system data warehouses highly preferred. • Knowledge and experience in VBC provider incentive distribution management programs and incentive funds flow preferred.

• Payer experience highly preferred. • Experience with CMS CMMI governmental programs related to Medicare and Medicaid highly preferred.

• Experience in population health and value-based care data repositories, third party software tools, and working with payer claims datasets highly preferred.

Knowledge and Skills:

• Excellent analytical and problem-solving skills, and the ability to make decisions quickly and independently.

• Strong attention to detail and well organized. • Adapts well to rapid change and multiple, demanding priorities with excellent time and project management skills.

• Ability to understand and interpret federal regulations and policies, coding guidelines and reimbursement changes.

• Interact effectively with colleagues in a variety of contexts and forums and contribute as a team player.

• Demonstrated ability to self-direct, multi-task and partner with technical staff from different departments.

• Microsoft Office Suite advanced proficiency also required, particularly Excel.

• Strong aptitude for learning additional software or systems as needed, particularly finance and revenue cycle billing systems.

• Able to work a hybrid schedule.

Certifications/Licenses:

• None

Workplace Conditions:

PHYSICAL DEMANDS:

• While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle or feel; and talk or hear

• The employee frequently is required to walk and stoop, kneel, crouch

• The employee is occasionally required to stand • The employee must occasionally lift and/or move up to 25 pounds.

• Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus

WORK ENVIRONMENT:

• General office environment and the noise level in the work environment is usually moderate

Benefits:

Sinai Health System’s goal is to provide you with the most comprehensive benefit package possible while balancing our fiscal commitments and obligations. Sinai Health Systems currently offers its employees the option to participate in a full range of benefits, including a health care program which includes medical, dental, vision and prescription coverage. Along with Employer Paid Life and Accidental Death & Dismemberment (AD&D), Supplemental Life, Short-Term and Long-Term Disability, Health Savings Account (HSA) and Flexible Spending Account (FSA), Employee Assistance Program and Student Loan Assistance. Participation in some programs requires that employees be regularly scheduled to work a minimum number of hours and/or to have fulfilled a waiting period after they begin employment with Sinai Health Systems. Registry (per diem) Caregivers are caregivers who work less than 1,000 hours in a calendar year. Registry caregivers are employees of Sinai Health System but are typically on an as needed basis. These caregivers may be called upon to cover full-time or part-time caregivers during PTO events or sick leave as well as to provide supplemental coverage. Registry Caregivers are not eligible for Sinai’s benefit programs with the exception for Sick-C, PPO Medical Plan, Employee Assistance Program (EAP) and non-match eligible contribution to the Sinai Health System Consolidated 403(b) retirement savings plan.

Living the Values:

• TEAMWORK - Caregiver works together with other caregivers to create and maintain an inclusive workplace where differences, inclusivity, conflict resolution and open communication are valued

• RESPECT - Caregiver shows mutual respect and fairness, treats each person with dignity and encourages each individual’s unique talents and contributions

• QUALITY - Caregiver improves our services by following protocol and suggesting improvements based on observations, continuous learning and industry best practices

• INTEGRITY - Caregiver holds self and others accountable for their actions and are honest and ethical in all dealings

• SAFETY - Caregiver practices behaviors that promote safety for all patients, visitors, and caregivers

• ROLE MODEL - Caregiver is a dependable role model and champions our values through their daily interactions with patients, customers and coworkers

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