Sr. Analyst Health Plan PACE

Care Synergy•Denver, CO

12h

About The Position

Care Synergy has an immediate opening for a Sr. Analyst Health Plan to manage Colorado PACE care plans. Location: Denver, CO Status : Full-time Schedule : Monday-Friday, 8-5 Annual Pay Rate: $83,387 - $97,968 Supplemental Pay: Based on position, schedule and/or availability: Paid Mileage/Shift Diffs/Stipends Mileage and Expense Reimbursement: Sixty-two and a half cents per mile – one of the highest in the industry! CULTURE, BENEFITS AND PERKS: We value engagement, community, and outreach initiatives and know it matters for our team members and our patients. We provide welcoming and supportive care to our patients and a work environment where all team members feel respected and valued. We support a culture of work-life balance and provide team members with two, free, confidential and robust benefit programs designed to provide solutions to the logistical and financial problems that arise in life. Employer pays over 90% of employee medical premium in some plans Health Savings Account (HSA) with significant Employer Funding: Single $1,000, Family $2,000 Healthcare Benefits are effective on the 1st of the month following 30 days of employment Extensive Paid Time Off (PTO/Vacation Pay/Sick Leave): 18 days in the first year for FT team members Seven Paid Holidays with an additional Floating Holiday 403(b) Retirement Plan with Employer Match: 50% match up to 8% of total compensation Company-Paid Life and AD&D Insurance Career & Logo wear Education Reimbursement Program Clinical Career Ladders Certification Pay Generous Discover-a-Star Team Member Referral Program Team Member Service Awards Early Wage Access Legal and Identity Protection Robust Leadership Development Training Programs REWARDING WORK YOU WILL DO: Manages the administration of CO PACE care plans via authorization and claims workflows. Serves as the primary liaison to the third-party administrator to resolve workflow and reporting discrepancies. Responsible for governmental and contracted provider relations and internal reporting and ensures timely and accurate results. Assists in the coordination of tracking, managing, and auditing of all contracted provider agreements. Manages participant capitation rates and regularly reconciles changes in Medicaid rates. Ensures TPA applies participant funds correctly by liaising with state to manage remits. Oversees Medicaid and Medicare enrollment, disenrollment, retention, and Medicare self pay, spenddown, including liaising with state to ensure proper approvals are obtained and payments are remitted. Assists with cash application, reconciles open AR and tracks down late payment. Responsible for Medicare Part D monitoring and works closely with operations to optimize payments. Helps to develop and implement an internal data system to track specific data elements including per member per month costs, Medicare Long Term Care Threshold level of care scores, participant obligation, hospitalization days and risk adjustment diagnosis codes, and other data elements as may be required. Prepares and submits federal and state required reporting as required including quarterly AR reconciliation and annual PRT reports and Medicare Part D bids as well as other external partners such as National PACE Org. Compiles internal reports and acts as a liaison between TPA/PBM and operations for any reporting discrepancies. Facilitates vendor management and serves as the primary point of contact between the organization and contracted providers by maintaining active contracts and paperwork (ie. W-9 and banking info ). Works closely with Care Synergy Contract Manager to track and maintain all provider contracts, amendments, correspondence and any related activities. Serves as the primary point of contact for access to HPM, HCPF and other relevant PACE IT systems or portals. Provides annual quality information to contracted providers as directed by regulation. Facilitates authorization and claims workflows, reviews and resolution of auth errors and pended or denied claims working closely with TPA and PBM. Regularly reviews IBNR to ensure all authorizations for care are reflected in the financial reports and works closely with TPA to resolve discrepancies. Tracks claims and invoices from authorizations to ensure prompt payment to contracted providers and vendors and directs the approval thereof. Coordinates reinsurance claims, collections and ensure reporting requirements are met timely and accurately. Prepares revenue and expense journal entries, reconciles books and assists with audits, internal and external. Assists in the development of new processes and workflows as the program grows and expands. WHAT WE ARE GOING TO LOVE ABOUT YOU: Minimum Education: Degree in Business, Finance, Public Health Administration, Health Care Management, Health Care Administration or related Human Services field. Minimum Experience: Five (5) years work experience; previous experience in healthcare data collection, analysis and reporting preferred. PHYSICAL REQUIREMENTS: Ability to lift/carry a minimum of 30 lbs. If you need assistance completing the electronic application please contact our Talent Acquisition team via email at [email protected]. You may also call the Human Resources Department at (303) 228-5647. Applications can be completed in-person at any one of our affiliate office locations. The Organization does not discriminate in employment opportunities or practices on the basis of race, color, religion, gender, gender identity, pregnancy, national origin, age, disability, creed, ancestry, genetic information, marital status, sexual orientation/identity, transgender status, military or veteran status, or any other characteristic protected by federal, state, or local law. This prohibition includes unlawful harassment based on any of these protected classifications.

Requirements

Degree in Business, Finance, Public Health Administration, Health Care Management, Health Care Administration or related Human Services field.
Five (5) years work experience
Ability to lift/carry a minimum of 30 lbs.

Nice To Haves

previous experience in healthcare data collection, analysis and reporting preferred.

Responsibilities

Manages the administration of CO PACE care plans via authorization and claims workflows.
Serves as the primary liaison to the third-party administrator to resolve workflow and reporting discrepancies.
Responsible for governmental and contracted provider relations and internal reporting and ensures timely and accurate results.
Assists in the coordination of tracking, managing, and auditing of all contracted provider agreements.
Manages participant capitation rates and regularly reconciles changes in Medicaid rates.
Ensures TPA applies participant funds correctly by liaising with state to manage remits.
Oversees Medicaid and Medicare enrollment, disenrollment, retention, and Medicare self pay, spenddown, including liaising with state to ensure proper approvals are obtained and payments are remitted.
Assists with cash application, reconciles open AR and tracks down late payment.
Responsible for Medicare Part D monitoring and works closely with operations to optimize payments.
Helps to develop and implement an internal data system to track specific data elements including per member per month costs, Medicare Long Term Care Threshold level of care scores, participant obligation, hospitalization days and risk adjustment diagnosis codes, and other data elements as may be required.
Prepares and submits federal and state required reporting as required including quarterly AR reconciliation and annual PRT reports and Medicare Part D bids as well as other external partners such as National PACE Org.
Compiles internal reports and acts as a liaison between TPA/PBM and operations for any reporting discrepancies.
Facilitates vendor management and serves as the primary point of contact between the organization and contracted providers by maintaining active contracts and paperwork (ie. W-9 and banking info ).
Works closely with Care Synergy Contract Manager to track and maintain all provider contracts, amendments, correspondence and any related activities.
Serves as the primary point of contact for access to HPM, HCPF and other relevant PACE IT systems or portals.
Provides annual quality information to contracted providers as directed by regulation.
Facilitates authorization and claims workflows, reviews and resolution of auth errors and pended or denied claims working closely with TPA and PBM.
Regularly reviews IBNR to ensure all authorizations for care are reflected in the financial reports and works closely with TPA to resolve discrepancies.
Tracks claims and invoices from authorizations to ensure prompt payment to contracted providers and vendors and directs the approval thereof.
Coordinates reinsurance claims, collections and ensure reporting requirements are met timely and accurately.
Prepares revenue and expense journal entries, reconciles books and assists with audits, internal and external.
Assists in the development of new processes and workflows as the program grows and expands.

Benefits

Employer pays over 90% of employee medical premium in some plans
Health Savings Account (HSA) with significant Employer Funding: Single $1,000, Family $2,000
Healthcare Benefits are effective on the 1st of the month following 30 days of employment
Extensive Paid Time Off (PTO/Vacation Pay/Sick Leave): 18 days in the first year for FT team members
Seven Paid Holidays with an additional Floating Holiday
403(b) Retirement Plan with Employer Match: 50% match up to 8% of total compensation
Company-Paid Life and AD&D Insurance
Career & Logo wear
Education Reimbursement Program
Clinical Career Ladders
Certification Pay
Generous Discover-a-Star Team Member Referral Program
Team Member Service Awards
Early Wage Access
Legal and Identity Protection
Robust Leadership Development Training Programs
Paid Mileage/Shift Diffs/Stipends
Mileage and Expense Reimbursement: Sixty-two and a half cents per mile