Cost and Utilization Specialist

8 hours ago


Troy, Michigan, United States Oakland Community Health Network Full time
Job Description

Job Title: Cost and Utilization Specialist

Job Summary:

The Cost and Utilization Specialist is responsible for analyzing and monitoring all financial activities. This includes budget preparation, developing and monitoring outcomes-based contracting rates, and working with contracted providers on reporting requirements.

The Cost and Utilization Specialist is a key member of the organization's budget and finance team.

Key Responsibilities:

  • Assists with preparation of all financial reports to Michigan Department of Health and Human Services (MDHHS) through the year.
  • Represents OCHN on financial workgroups.
  • Works with other cost and utilization analysts to help them understand the service models developed by OCHN and develop efficient rates for the provider network.
  • Reviews the monthly financials and provides feedback to the Director of Financial Analytics.
  • Attends monthly/quarterly meetings with the provider network and provides financial updates.
  • Understands fund source allocation for revenue and expense reporting.
  • Ability to organize and lead meetings with other OCHN departments and provider network.
  • Acts as a liaison between the provider network and MDHHS to communicate feedback regarding changes to funding, procedure codes, and reporting requirements.
  • Collects, analyzes, and interprets data and statistics using quantitative and qualitative methods. Prepares and presents complex and detailed statistical reports.
  • Uses integrated relational computer systems to create and access database files and prepare statistical charts, graphs, and exhibits.
  • Provides statistics and established benchmarks regarding cost and utilization statistics.
  • Initiates, manages, and reports on projects using standard project management, cost accounting, and budget management principles. Monitors scope, schedule, and budget of project/program and coordinates project/program evaluation and improvements.
  • Compiles, analyzes, and reports on operational information including trends, staffing/resource allocation, and budgeting.
  • Performs cost analysis and project costs associated with OCHN programs.
  • Conducts comprehensive surveys and research projects, including assisting with program evaluation studies and other administrative studies.
  • Serves as financial support person for OCHN departments.
  • Serves as primary financial liaison between OCHN contract providers regarding financial issues.
  • Coordinates the financial activities policies, procedures, and directives between the contract providers and OCHN.
  • Assures that Contracted providers comply with all financial policies and directives.
  • Tracks, analyzes, and monitors all costs and utilization for contract providers.
  • Prepares, analyzes, and monitors budget for contract providers.
  • Develops and implements outcomes-based contracting rates using statistical analysis.
  • Provides recommendations for improvements and changes in procedures, costs, and utilization to increase system efficiencies and effectiveness.
  • Other duties as assigned by the Director of Financial Analytics.

Job Requirements and Qualifications:

Education:
  • Bachelor's degree in Business Administration, Finance, Accounting, or Related discipline.


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