Financial Analyst I-Rate Specialist (Full Time, Remote, North Carolina Based)

Alliance Health•Durham, NC

2h•$61,439 - $78,335•Remote

About The Position

The Rate Specialist updates and monitors provider rates. This position will ensure the rates paid to providers for Medicaid, State, and other member services are aligned with cost-based methods that are both financially viable for Alliance and that will financially support the provider and promote quality of services to members. This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to come into the Alliance Office for business and team meetings as needed.

Requirements

Associates Degree in Business Administration, Finance, Public Policy, Hospital Administration, or related field and at least four (4) years of related experience in financial analysis with demonstrated capacity to independently draw inferences and to communicate findings or an equivalent combination of education and experience.
Bachelor’s Degree in Business Administration, Finance, Public Policy, Hospital Administration, or related field and at least two (2) years of related experience in financial analysis with demonstrated capacity to independently draw inferences and to communicate findings
Considerable knowledge of standardized accounting practices and principles
Knowledge of program components and accounting processes.
Knowledge of accounting and auditing principles and practices.
Skill in communicating, both orally and in written form.
Advanced skills with Microsoft products, particularly Excel and Access
Ability to apply and explain accounting practices.
Ability to interpret and analyze accounting data.
Ability to interpret and apply common to moderately complex Federal and State fiscal regulations
Ability to analyze and correct financial problems and accounting errors.
Ability to prepare interpretive or analytical Accounting or financial reports
Ability to determine compliance with pertinent guidelines, rules, regulations, and laws.

Nice To Haves

A background in managed healthcare, insurance operations preferred

Responsibilities

Maintain Alliance rates
Maintain and update rates within the Alliance Claims System (ACS) according to the applicable benefit plan and ensure the integrity of the rates data in the system
Ensure that rates are in line with Medicaid published rates where applicable
Update and track provider and member specific enhanced rates by specific categories of service
Complete service rate changes and initializations
Develop and maintain process flows and procedures to address all aspects of rate setting and maintenance
Maintain Alliance published rate schedule
Conduct regular reviews of State published material
Maintain knowledge of internal and external healthcare fee schedules and analyze comparable provider rates from other payers
Participate as needed in conversations with NC Department of Health and Human Services (NC DHHS) regarding rates
Regularly review rate material published by NC DHHS and prepare rate updates according to contractual requirements
Conduct financial analysis in response to rate change requests
Work closely with Provider Networks and/or Clinical Operations to analyze payment methodologies for In Lieu of Services and Alternative Payment Arrangements
Collaborate on new provider rate projects and other strategies to develop financially viable payment structures
Work with EVP/Chief Financial Officer and Finance Manager in developing reimbursement rate offers for providers, including accurate, easy-to-understand analysis of the negotiated rates for communications with providers
Assist with internal and external inquiries to resolve provider reimbursement issues
Collaborate with Provider Networks in communicating to provider community
Work closely with the Claims Department, Provider Networks, Information Technology, and Utilization Management Departments
Improve reporting and input capabilities
Evaluate all internal (MicroStrategy) reports related to provider or member rates for their usefulness and accuracy. Recommend changes to aid in the ability to enhance and effectively manage our rates and reporting process
Work with IT to develop processes for easier rate updates in ACS
Help develop routine and ad-hoc reports for internal review