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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. This role will play a critical part in ensuring the financial reporting and analysis responsibilities for the oversight of the Revenue Management and/or Risk Adjustment programs for all government-funded product lines.

Key Responsibilities
  • Coordinate monthly and ad-hoc data submissions, monitoring data for accurate tracking and reporting of medical, drug claim data, and membership data to CMS RAPS, EDPS, and DDPS and Edge Server.
  • Produce, distribute, monthly, quarterly, and annual key performance indicators (KPIs) and error/rejection detail for all report submissions and external vendor support system data correction.
  • Premium reconciliation reports for monthly financial close; file payment issues with CMS and monitor response; monitor MMR accruals; estimate risk adjustment premium impact for final reconciliation with CMS; allocation of premium to at-risk provider networks.
  • Maintenance of the following queries and analysis: Reconciliation reports for Risk Adjustment, Reinsurance, Risk Corridors, APTC, Cost Sharing, and Part D program receivables and payables for monthly accounting needs. Monitor accruals for final reconciliation with CMS and cost sharing.
  • Develop and enhance reporting capabilities for financial and operational performance.
  • 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, Medical Loss Ratio reporting.
  • Produce reports to provide M&B discrepancies in the premium payments from CMS. Team with Membership & Billing staff to identify and resolve enrollment, claims, provider, and premium discrepancies. Develop detail to support reporting discrepancies to CMS for discrepancies outside of M&B's influence.
Requirements
  • Bachelor's degree in Accounting, Finance, Business Administration, or a related field (must include financial or accounting-related coursework) required.
  • Master's degree (Finance, Business Administration, etc.) preferred.
  • Completion of Advanced Access, Excel, GQL, Cognos, or SQL training preferred.
  • Two (2) years of Accounting/Finance business-related experience required.
  • Two (2) years managing projects and initiatives designed to improve business operations required.
  • Three to five (3-5) years of experience developing, analyzing, interpreting & trending data preferred.
  • Experience with Medicare Advantage, Medicare Part D, Medicaid, or Qualified Health Plans preferred.
  • Experience in health care 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.