Finance Program Manager (Performance Analytics)

Mercy Health BSMH • Any City, OH

1d

About The Position

Population Health (PH) manages a complex group of entities that consolidate to Health Select Services (HSS), with over 730K lives and revenues of over $200M annually. HSS is the BSMH division for value-based care delivery. Subsidiaries include Mercy Health Services ACO/CIN, Hampton Roads Good Help ACO, Southeastern Health Partners, Health Select Services South Carolina CIN, Health Select Services Virgina CIN, and Population Health Service Organization (supporting entity). Other structures and entities may be added through our continued growth. The role works across PH management, staff, BSMH shared services, key vendors, market leaders, clinical leaders, and both employed and affiliated medical groups. The Population Health Finance Program Manager for Performance Analytics leads analysis on Population Health data sets and programs. This role focuses on program financial performance at a ACO, TIN and NPI level to include MSSP (Medicare Shared Savings Program) and Medicare Advantage. This role works with the external actuarial consulting team, other vendors, internal finance, IT/analytics, and brings strong knowledge of healthcare data sets. The role requires experience working in health insurance, value-based care contracting, Accountable Care Organizations (ACOs), Clinically Integrated Networks (CINs), and other risk-based health care delivery due to the complexity and knowledge level required for success. It requires prior experience working in Medicare CCLFs and building out custom analyses in Excel and other tools. The role supports forecasting and scenario modeling, and ensures the accuracy and integrity of financial datasets. The role translates actuarial and management guidance into financial forecasting across the entities to optimally grow PH operating performance while remaining compliant with appropriate financial and operating BSMH controls.

Requirements

• Bachelor’s degree in Health Informatics, Data Analytics, Accounting, or related field (required)
• 5-10 years in healthcare finance/accounting and analytics
• Proficiency in SQL, Tableau, Excel, and familiarity with relational database
• Specific Knowledge and Experience Working in: Medicare CCLFs and Payer Claims files
• Working in Milliman Medinsight and/or other claims-based data warehouses
• For MSSP, experience with: CCLF summary analysis, Claims analysis, BDCA early insights indicators, TIN and NPI level performance
• For MA, experience with: Payer claims analysis, Reconciliation report analysis, Star Rating forecasting and analysis, TIN and NPI level performance
• Hard/Tech/Clinical Skills: Healthcare finance and accounting know-how, SQL querying and data extraction, Claims and eligibility data analysis, Tableau or equivalent data visualization tool, Financial modeling and forecasting, KPI development and monitoring, Relational database navigation and query optimization, Excel (advanced formulas, pivot tables, lookups), HIPAA compliance and PHI protection practices, Data validation and audit preparation, Healthcare performance metric analysis (cost, utilization, quality)
• Soft/Interpersonal Skills: Critical thinking and analytical reasoning, Clear and concise communication, Attention to detail and accuracy, Time management and meeting deadlines, Collaboration and team-based problem solving, Translating data into actionable recommendations, Adaptability to evolving priorities, Stakeholder engagement and relationship building, Initiative and self-motivation, Integrity and accountability in data handling

Nice To Haves

• Master’s degree in Business Administration, Finance, Health Informatics, or related discipline (preferred)
• Working in Epic (preferred, not required) data with IT support

Responsibilities

• Evaluates and translates performance in full risk arrangements, including Medicare and Medicare Advantage programs, into financial guidance; tracks performance under all value-based arrangements attributed to PH, bundled payment and shared savings program methodologies.
• Analyze claims, eligibility, and contractual data from CMS and Payers to identify financial trends, risks, and opportunities
• Studies statistical data to create an analysis; estimates of probability, benchmarks and likely costs for a segment or population
• Uses PH tools, claims and eligibility and attribution data and other reporting systems and sources to provide clinical, financial, utilization, and claims analytics.
• Develops trend analysis reports that monitor key performance indicators and compares them to internal and external benchmarks; uses this data to assist leadership in decision-making, planning and implementing performance improvement strategies.
• Sets targets by TINs, providers, markets, and reports against target vs. actual performance, working with our ACO/CIN network team
• Serves as a hands-on analyst to review workflows and documentation
• Perform routine audits and analytics for existing value-based programs to validate attribution, quality performance and financial reconciliations; monitors internal controls and makes recommendations for improvements, including coordinating across BSMH Internal Audit, third-parties, other internal stakeholders.
• Ensure HIPAA compliance, adherence to data governance standards, and protection of PHI
• Provide ad hoc analyses to support financial planning, vendor performance reviews, and strategic initiatives.

Benefits

• Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
• Medical, dental, vision, prescription coverage, HSA/FSA options, life insurance, mental health resources and discounts
• Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
• Tuition assistance, professional development and continuing education support

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level