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Supervisor, Hospital Risk Pool Analyst

4 months ago

Los Angeles, United States MedPOINT Management Full time
Job DescriptionJob Description

Summary:

 

The Hospital Risk Pool Financial Analyst Supervisor leads, manages and oversees the Team of Hospital Risk Pool Financial Analyst in preparation and delivery of financial, clinical, and business analysis. This includes the accurate quantification and measurement of clinical outcomes. In addition, other key responsibilities include the oversight and development of operating plans and financial solutions that promote an environment of effective decision-making, revenue enhancement, cost efficiency, and sound business practices. Candidate will work closely with other hospital teams to develop and package financial products and other reports catered to meet the specific needs of MPM customers. Candidate will spearhead operationalizing the transition of the accounting functions and financial reporting into the ERP. Candidate will ensure the effective and timely delivery of quality financial/information products and reports to MPM clients. The Risk Pool analyst Supervisor is a key liaison and "front-line" financial resource between Hospital Operations and Finance leadership and serves to create a forward-focused guiding vision and environment of "no surprises". The Supervisor will provide the reporting overview and represent the Finance team at all client joint operations committees or meeting (JOC or JOM)

 

Duties and Responsibilities:

· Review Hospital Capitation detail and summary reports monthly to ensure Analysts have captured in the financial reports accurately

· Oversee the identification of cost drivers and drill down with the Team utilizing paid claims reports monthly and/or quarterly to calculate claims cost

· Analyze and review lag report for claims paid and received

· Calculate/update IBNR model using Lag reports and/or other appropriate methodologies

· Oversee and review the preparation of Risk Pool summaries by health plan, line of business and aid category.

· Oversee and review the preparation Risk Pool summary with combined health plans

· Oversee and review the preparation Capitation summary by health plan, line of business and by aid category

· Oversee and review the preparation of the report of claims by month and type of service

· Disperse reports to hospital client and Leadership and present at appropriate client JOMs

· Oversee and review the preparation and maintenance of daily cash flow and monthly bank reconciliation

· Oversee and review the preparation and submit any additional requested reports to hospital clients

· Oversee and review the preparation EOM financial and board packages

· Oversee and review the preparation ad-hoc financial analysis as requested by the Controller, CFO and/or the client

· Oversee and review the preparation of other financial packages and ad-hoc reports as needed to present for Operations Meeting (JOM)

· Build automation of data mining needed for Risk Pool financial reporting

· Develops and validates queries through SQL for the successful extraction of appropriate data.

· Create ad hoc reporting and queries as needed to respond to management inquiries.

· Examine, assess, and document business operations and procedures to ensure data integrity and process optimization.

· Create, review and analyze hospital financial risk pools to ensure a complete understanding of the performance of each hospital risk pool and all factors that influence its performance.

· Identify issues that require additional investigation and evaluation, as well as, validate discrepancies and coordinate with internal and external departments to ensure accuracy.

· Prepare reports on a regular basis; ad hoc, monthly and quarterly for internal use and for clients, as well as, prescheduled joint operations meetings (JOMs).

· Respond to inquiries from hospital clients and other departments related to hospital client needs.

· Prepare the narrative required to present current performance of the risk pool to clients

· Lead and hold meetings with clients, Analysts and internal Leadership and be able to speak to issues and concerns that may arise

· Lead optimized efficiency with document generation and reporting.

· Review risk pool contracts and interpret them into a schedule of payments for tracking purposes and ensure timely settlement payments are made

 

Minimum Job Requirements:

Education: Bachelor’s degree (Accounting/Finance) or an equivalent combination of education, training and experience is required.

Experience: 5+ years of Physician Organization or Health Plan, Hospital Finance and/or Health Plan experience

Definitive understanding of provider and health plan contracting, delineation of risk, medical terminology and standard industry reimbursement methodologies required.

License/Certification/Special Training: SQL, Microsoft Suite with focus on Access and Excel, PowerBi

 

Knowledge, Skills and Abilities Required:

· Demonstrates advanced knowledge with Excel, Power Point and other Microsoft Office Systems required.

  • Must be highly analytical and possess a strong grasp of finance concepts such as capital budgeting, discounted cash flow, financial statement analysis and forecasting.

· Ability to communicate clearly and effectively, work accurately, meet deadlines and provide effective reporting is required.

· Excellent interpersonal skills required to develop and maintain effective working relationships across all levels within the organization.

· Ability to work both independently and as part of a team.

· Meets tight deadlines and provides accurate information.

· Demonstrate ability to plan, organize and manage modest projects successfully.

· Detail -oriented, excellent proof reading and editing skills.

· Must be able to learn unfamiliar concepts quickly

· Requisite poise, judgment, and trustworthiness to represent MSO to internal and external groups

· Must work effectively in a team environment and able a supportive contributor or leader in team matters. Must conduct him or herself professionally and be capable of developing and maintaining positive, service oriented relationships with all levels of healthcare professionals, both internal and external to MPM, as well as Board members, administration and others.

· Must be able to plan, coordinate and prioritize resources.

· Maintains information in a confidential manner and complies with HIPAA laws according to policy.

· Advanced knowledge of Microsoft Office Suite, including but not limited to Word, Excel, and PowerBi.

· Ability to prioritize time

· Ability to adapt and change gears, take on special projects and work on tasks outside of current scope.

· Strong Microsoft SQL Server – strong SQL (‘select from where’), query tuning, Views, functions, job schedule

· Excel - integrating with SQL Server; pivots; lookups

· Create PowerBI Reports from a myriad of data sources

· Reprocess Excel data using Power query (ETL)

 

 

Working Conditions and Physical Effort:

 

· Regular and reliable attendance is an essential function of the position.

· Work is normally performed in a typical interior/office work environment.

· No or very limited physical effort required. No or very limited exposure to physical risk.