Sr. Managed Care Analyst

2 weeks ago

Roseville, United States Adventist Health Full time
Job Description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Analyzes data and other information to support organizational strategic initiatives around risk-based healthcare arrangements. Measures and evaluates the financial performance of managed care capitation and risk arrangements across the System. Provides key financial, membership and utilization reports to System/Ministry leadership to provide insights into strategic business questions. Identifies areas of opportunity to improve performance of the System's risk arrangements.

Job Requirements:

Education and Work Experience:
  • Associate's/Technical Degree or equivalent combination of education/related experience: Required
  • Bachelor's Degree: Preferred
  • Five years' technical experience: Preferred
Essential Functions:
  • Prepares and posts monthly general ledger activity to the accounting system for all capitation arrangements across the System, including but not limited to, premium revenue, stop-loss insurance, purchased services, incurred-but-not-reported (IBNR), administrative expenses and incentive-based revenue. Acts as technical expert and serves as a resource for System/Ministry leadership for risk-based financial reporting considerations. Develops standard management reports to evaluate the financial/utilization performance of capitated arrangements. Prepares and submits routine financial regulatory reports and assist in the facilitation of audits around regulatory and financial reporting.
  • Calculates the surplus/deficit settlement amounts for risk-sharing arrangements based on specific contractual provisions. Provides reports to executive System and Ministry leadership. Coordinates a timely collection of monthly capitation premium payments and eligibility/revenue data from various payers. Analyzes membership data to ensure proper collection of payments and works directly with the payer to resolve discrepancies. Maintains a summary report that provides key membership and revenue details, including impacts from retro-activity and other manual adjustments. Works on activities of a diverse scope requiring minimal interpretation of policies and guidelines.
  • Organizes and maintains capitation contracts and agreements. Reviews existing/new contracts for financial implications and presents findings to management, ensuring proper inclusion within financial management reporting. Produces analytics by using business analytical/visualization systems to identify opportunities for improving performance when compared to budgeted Incurred But Not Reported (IBNR) use rates and benchmarks. Documents and provides valuable insights to current claim/s trends which affect the movement of IBNR. Reports insights to financial management, providing context during the financial statement close process.
  • Acts as technical expert on IBNR and serves as a resource to System/Ministry leadership for risk-based utilization and claims expenses. Provides support, through preparation of ad-hoc utilization and financial reports, to System/Ministry management who routinely use/rely on capitation analytics/data in their job responsibilities. Validates the quality and accuracy of underlying data used for analysis and financial reporting.
  • Works under limited guidance and within broad guidelines and technical standards. Assists with orienting and providing on-the-job skills training to others.
  • Performs other job-related duties as assigned.


Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.

About Us

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 90 communities on the West Coast and Hawaii with over 400 sites of care, including 26 acute care facilities, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of 37,000 includes employees, physicians and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

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