Revenue Management Specialist III

2 weeks ago

Troy, Michigan, United States Health Alliance Plan of Michigan Full time

Senior Analyst, Revenue Management and Risk Adjustment - Health Alliance Plan

GENERAL SUMMARY:

The role is designed to support the Revenue Management and Risk Adjustment division in overseeing the Financial Reporting and Analysis tasks related to government-funded product lines. Under the guidance of the Department Manager, the analyst will be responsible for various key functions.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  1. Coordinate monthly and ad hoc data submissions, ensuring accurate tracking and reporting of medical and drug claim data to CMS.
  2. Generate and distribute monthly, quarterly, and annual key performance indicators (KPIs) along with error/rejection details for all report submissions.
  3. Prepare premium reconciliation reports for the monthly financial close, addressing payment issues with CMS and monitoring responses.
  4. Maintain queries and analysis for Risk Adjustment, Reinsurance, and other financial reporting needs.
  5. Enhance reporting capabilities for both financial and operational performance.
  6. Participate in annual financial reporting activities, including CMS bid filings and financial audits.
  7. Collaborate with Membership & Billing staff to resolve discrepancies in premium payments from CMS.
  8. Monitor CMS materials for compliance and implement necessary changes in collaboration with management.
  9. Develop and maintain departmental policies and procedures to ensure audit readiness.
  10. Assist in testing IT projects and new system initiatives.
  11. Analyze department reports to identify data integrity issues and propose improvement solutions.
  12. Support the department in routine assignments and ad-hoc projects, ensuring deadlines are met.
  13. Perform additional related duties as assigned.

EDUCATION/EXPERIENCE REQUIRED:

  • Bachelor's degree in Accounting, Finance, Business Administration, or a related field with relevant coursework.
  • Master's degree in Finance or Business Administration is preferred.
  • Completion of training in Advanced Access, Excel, GQL, Cognos, or SQL is preferred.
  • Minimum of two years of experience in Accounting/Finance.
  • Experience managing projects aimed at improving business operations is required.
  • Three to five years of experience in data analysis and interpretation is preferred.
  • Familiarity with Medicare Advantage, Medicare Part D, Medicaid, or Qualified Health Plans is advantageous.
  • Experience in healthcare finance is preferred.
  • Knowledge of the Affordable Care Act (ACA) is beneficial.
  • Proficient in Windows applications, particularly Excel and Access.
  • Ability to research, analyze, and implement process improvements is essential.
  • Strong written and verbal communication skills are required.
  • Problem-solving and decision-making skills are crucial.

Health Alliance Plan is a nonprofit health plan dedicated to providing comprehensive health coverage. As a subsidiary of Henry Ford Health System, we strive to enhance the health and well-being of our members through collaboration with healthcare providers and community organizations.

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