Financial Analyst

SCAN Health Plan • Long Beach, CA

7d • Remote

About The Position

The Financial Analyst assists the manager in leading the department to ensure accurate system configuration, capitation payment processing, accruals, shared risk pool calculation, and claims expense recording. Interprets contractual agreements to ensure system accuracy and compliance. Manages databases and ensures that provider payments are accurate. Ensures data integrity for audit and bid process for all entities.

Requirements

• Associate's Degree or Technical Degree or equivalent experience.
• 3-5 years of related experience.
• Performs work under minimal supervision.
• Handles complex issues and problems, and refers only the most complex issues to higher-level staff.
• Possesses comprehensive knowledge of subject matter.
• Provides leadership, coaching, and/or mentoring to a subordinate group but does not directly supervise.
• Technical expertise - Advanced analytical skills.
• Problem Solving - Basic problem-solving skills.
• Communication - Good communication and interpersonal skills.
• Microsoft Office Suite at advanced level required.
• A background check is required.

Nice To Haves

• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

Responsibilities

• Facilitates and leads intradepartmental meetings required for audit, accruals, data analysis, annual Center for Medicare and Medicaid Services (CMS) bids, capitation and claims reserves
• Oversees timely and accurate completion of all shared risk pool settlements on a quarterly and annual basis and provides guidance for the team on technical aspects of contract language
• Liaison with Network Management, Shared Services, Claims, Legal, Actuary, Compliance and Enrollment to ensure accuracy of provider contract application in the system for explicit capitation calculations and payment
• On-going testing, validation, monitoring and financial reporting of the capitation module with continued efforts relating to processes improvement, CMS guidelines and system upgrades
• Responsible for the maintenance and data integrity of the capitation and shared risk modules by managing the configuration, analysis documentation, and testing of the system set-up to support current and future operational needs and compliance requirements
• Mentors team by providing guidance, support, and assisting with escalated issues and tasks, as needed
• Assures timely and accurate monthly provider capitation payments
• Creates system documentation, including process flow and desk top procedures
• Ensures compliance by evaluating new, proposed, and existing contractual agreements as they relate to payment methodologies for both capitated and shared risk arrangements (Medical Groups, Hospitals, and Ancillary Providers)
• Timely response and resolution to Network Management inquiries
• Provides management with planning and control information by assembling and analyzing historical financial data, identifying trends, providing forecasts, explaining processes and techniques, recommending actions and revisions and departmental improvements, as needed
• Contributes to team effort by accomplishing related results, as needed
• Ensures CMS bid accuracy by providing detailed and complex capitation and accrual data (member level detail) on a GAAP to incurred basis
• Collaborates and provides analytical support to the Finance, Network Management, Pharmacy and Health Care Informatics departments by assimilating data from multiple sources into clear meaningful reports in support of specific accruals and reserves for multiple programs and entities
• Compiles and presents complex capitation information by organizing and explaining data, assumptions and recommendations, as needed.
• Initiates membership and payment audits and ensures efficiency in the capitation process
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Benefits

• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
• Excellent 401(k) Retirement Saving Plan with employer match and contribution
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree