Senior Analyst of Revenue Management and Risk Adjustment

2 weeks ago


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

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

GENERAL SUMMARY:

The Revenue Management and Risk Adjustment department (RMRA) plays a critical role in overseeing the Financial Reporting and Analysis functions related to government-funded product lines. Under the guidance of the Department Manager, this position is essential for ensuring compliance and accuracy in reporting.

KEY RESPONSIBILITIES:

  1. Coordinate the submission of monthly and ad hoc data, ensuring precise tracking and reporting of medical and drug claims data, as well as membership data to CMS RAPS, EDPS, DDPS, and Edge Server.
  2. Generate and distribute monthly, quarterly, and annual key performance indicators (KPIs) and detailed reports on errors and rejections for all submissions and external vendor data corrections.
  3. Prepare premium reconciliation reports for the monthly financial close, addressing payment issues with CMS and monitoring responses, as well as estimating risk adjustment premium impacts for final reconciliation.
  4. Maintain and analyze reconciliation reports related to Risk Adjustment, Reinsurance, Risk Corridors, APTC, Cost Sharing, and Part D program receivables and payables.
  5. Enhance reporting capabilities for both financial and operational performance metrics.
  6. Engage in annual financial reporting activities, including CMS bid filings, HCR Premium Development, and financial audits.
  7. Collaborate with Membership & Billing teams to identify and resolve discrepancies in premium payments from CMS.
  8. Monitor CMS communications for compliance requirements and collaborate with management on necessary system or process changes.
  9. Develop and uphold departmental policies and procedures to ensure audit readiness and compliance with HAP standards.
  10. Coordinate tasks related to testing IT projects and new system initiatives.
  11. Analyze departmental reports to identify data integrity issues and propose improvement solutions.
  12. Assist in routine assignments and ad-hoc projects, ensuring deadlines are met.
  13. Perform additional duties as assigned.

EDUCATION AND EXPERIENCE REQUIRED:

  • Bachelor's degree in Accounting, Finance, Business Administration, or a related field with a focus on financial or accounting coursework.
  • Master's degree in Finance or Business Administration is preferred.
  • Completion of advanced training in Access, Excel, GQL, Cognos, or SQL is preferred.
  • A minimum of two years of experience in Accounting/Finance is required.
  • Experience managing projects aimed at enhancing business operations is essential.
  • Three to five years of experience in data development, 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 a plus.
  • Proficiency in Windows, particularly Excel and/or Access, is required.
  • Ability to prepare data for reports and presentations is essential.
  • Strong written and verbal communication skills are necessary.
  • Problem-solving and decision-making skills are critical.

ABOUT HEALTH ALLIANCE PLAN:

Health Alliance Plan is a nonprofit health plan based in Michigan, dedicated to providing health coverage to individuals and organizations. As a subsidiary of Henry Ford Health System, we collaborate with healthcare providers and community groups to enhance the health and well-being of our members. Our team of over 1,100 committed employees strives to simplify healthcare access for all.

BENEFITS:

Health Alliance Plan offers a comprehensive employee benefits program, including retirement plans, tuition reimbursement, paid time off, and wellness programs, designed to support the diverse needs of our workforce.



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