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Revenue Management Risk Adjustment Analyst III

2 months ago

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

**Job Summary:**

We are seeking a highly skilled Revenue Management Risk Adjustment Analyst III to join our team at Health Alliance Plan of Michigan. As a key member of our Revenue Management and Risk Adjustment department, you will play a critical role in ensuring the financial integrity of our organization.

**Key Responsibilities:**

  • Coordinate and analyze data submissions to ensure accurate tracking and reporting of medical, drug claim data, and membership data to CMS RAPS, EDPS, and DDPS.
  • Develop and distribute monthly, quarterly, and annual key performance indicators (KPIs) and error/rejection detail for all report submissions and external vendor support system data correction.
  • Prepare premium reconciliation reports for monthly financial close and file payment issues with CMS and monitor response.
  • Maintain queries and analysis for reconciliation reports, risk adjustment, reinsurance, risk corridors, APTC, cost sharing, and Part D program receivables and payables.
  • Develop and enhance reporting capabilities for financial and operational performance.
  • Support annual financial reporting activities, including CMS bid filings, HCR Premium Development, RFP on financial Risk Adjustment projects, Employer Group Rate Renewals, financial audits, CMS Attestations, premium and member revenue budgets, and Medical Loss Ratio reporting.
  • Identify and resolve enrollment, claims, provider, and premium discrepancies with Membership & Billing staff.
  • Monitor CMS material and calls for required compliance and system or process changes and work with management on design and implementation.
  • Develop and maintain departmental policies and procedures for audit purposes and support department in adhering to HAP Compliance department requirements.
  • Coordinate and assign tasks related to testing IT projects and new system-related initiatives and CMS software releases.
  • Analyze department reports to identify data integrity issues, system, and programming problems, and work with management to develop and implement improvement solutions.

**Requirements:**

  • Bachelor's degree in Accounting, Finance, Business Administration, or a related field with financial or accounting-related coursework.
  • Master's degree in Finance, Business Administration, or a related field preferred.
  • Two years of Accounting/Finance business-related experience required.
  • Two years of managing projects and initiatives designed to improve business operations required.
  • Three to five years of experience developing, analyzing, interpreting, and trending data preferred.
  • Experience with Medicare Advantage, Medicare Part D, Medicaid, or Qualified Health Plans preferred.
  • Experience in healthcare finance preferred.
  • Affordable Care Act (ACA) experience or knowledge preferred.
  • Knowledge of HAP's Core system operations and functionality preferred.
  • Knowledge of business principles and functions required.
  • Proficient knowledge of Windows - Excel and/or Access required.
  • Proficient at using various data sources to develop relevant reporting tools and to use those tools to enhance processes and procedures required.
  • Knowledge of accounting and financial reporting principles and business functions required.
  • Ability to research, analyze, interpret, trend, and implement process improvement initiatives required.
  • Ability to collect and prepare data for written/oral presentation - report creation and generation required.
  • The ability to work effectively with all levels within the organization required.
  • Excellent written and verbal communication skills required.
  • Well-defined problem-solving and decision-making skills required.