Associate Director Cap Revenue Healthcare Economics - Remote

UnitedHealth Group•Worcester, MA

22d•Remote

About The Position

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. Under executive direction, the Associate Director Cap Revenue Healthcare Economics Optum Massachusetts is responsible for all aspects of assessing, evaluating, and estimating capitation revenue and net capitation for Optum Massachusetts. Responsible for complex trend analysis and reporting to inform senior management’s decision making regarding the level of changes for financial statement reporting. Makes recommendations and provides critical professional expertise to inform senior management of amounts to record in the financial statements. Assesses and ensures the integrity, accuracy and consistency of the financial and utilization reports and databases and leads action plans for making improvements. Manages staff, consisting primarily of financial analysts. As the accountable business owner, oversees the implementation of changes to the databases, reports, and processes as dictated by changes in business needs to support the recording of capitation revenue in the financial statements. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements

Bachelor’s degree (or equivalent experience), Bachelor’s preferably in accounting, finance, mathematics or actuarial science
5+ years of experience in financial data analysis including experience in a managerial, supervisory or lead role
Experience in healthcare or health insurance
Background in financial modeling and forecasting
Ability to build relationships and negotiate with external (ie, payers and providers) and internal (ie, finance, contracting, medical management, data warehouse) customers and develop a solid case for positive financial and other outcomes
Demonstrated project management skills
Microsoft Excel and SQL experience
Proven excellent analytical and quantitative skills including statistical analyses
Demonstrated ability to work standard business hours in EST zone

Nice To Haves

MBA
Actuarial Certification
Experience in a supervisory or lead role
Knowledge of provider/facility contracting is a plus
Proven detail oriented with solid technical writing, communication, and presentation skills

Responsibilities

Oversees all aspects of calculation of capitation revenue under full and shared risk payer contracts
Produces detailed work papers for all full risk and shared risk arrangements for entities within Optum Massachusetts, that replicate how CDO gets reimbursed by the payors; alignment with settlement reports, dashboards and other monthly reports received from payors
Responsible for supporting all amounts recorded by accounting and ensuring that proper financial controls are in place to verify amounts recorded
Tracks covered lives to provide forecast (in partnership with Clinical Operations) and creates monthly reporting
Responsible for quarterly forecasts, and related deliverables (ie, bridges, RAF capture reporting, supplemental schedules for membership, rates, risk revenue, risk IOI, etc); create forecast model for membership and rates
Develops long range planning model, and monthly collaboration with accounting team
Delivers key indicators, and metrics to senior leadership and various stakeholders highlighting gaps and opportunities (ie, RAF capture, acuity adjustments) monthly; helps create and delivers risk contract performance narrative (net cap)
Creates lines of business reports that show profitability of different payor contracts, and margins on reported and restated basis; analyze similarities and differences of contract performance across the market; identify risks and opportunities for Senior Leadership and various stakeholders
Collaborates with other members of HCE team, FPA, Contracting, and Accounting on a regular basis
Responsible for maintaining Axiom Health Plan budgeting module and spreading it to Optum Massachusetts
Generates Optum Massachusetts reporting; establishes source of truth, margins, and BCR
Produces internal reporting such as, but not limited to, Hoshin metrics, HBI, forecast model, others as applicable
Partners with business leaders and build solid relationships in support of financial performance; act as a strategic thought partner for the business
Drives intersegment agreements between Optum Massachusetts and UHC entities along with understanding the financial impacts
Partners across Optum Massachusetts finance team to help lead integration activities
Recommends proposals to Contracting Supports Contracting Department discussions and evaluation of managed care contract terms; may propose changes in the contracts to the Contracting Department Leadership
Provides input and information to facilitate successful payer negotiations on payer financial performance; works closely with the Contracting Department to estimate and manage the preparation of detail settlement documents for recovery of funds based on contractual arrangements with payers and hospital risk-sharing partners
Works collaboratively with the Controller to reach agreement on the final annual contract financial results
Performs other duties as assigned
Manages a team of financial analyst professionals including all aspects of subordinate staff responsibilities Carries out managerial responsibilities within areas of responsibility in accordance with the organization's policies and applicable laws Provides direction and support to staff to assure departmental effectiveness and efficiency Responsibilities include interviewing, selecting, orienting, and training employees; planning, assigning, and directing work; evaluating performance; rewarding and issuing corrective action to employees; reviewing personnel actions of staff and addressing complaints and resolving problems