Healthcare Financial Analyst, South San Francisco, CA
Healthcare Financial Analyst
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Healthcare Financial Analyst to perform routine and complex financial analysis and reporting to assist HPSM in the management of health care costs for all lines of business and to ensure adherence to reporting and reconciliation requirements with the State and CMS.
The essential duties & responsibilities will include the following:
- Develop and prepare decision support tools to advise HPSM on activities related to forecasting, trend development, medical utilization, provider contracting, and State capitation and reimbursement rates.
- Review claims payments for accuracy based on contract terms and Medi-Cal and Medicare guidelines.
- Calculate estimated costs of new products and programs and changes to provider reimbursement rates or methodologies.
- Review proposed capitation rates from the State for adequacy.
- Prepare monthly and quarterly overview reports on medical cost performance and trends.
- Complete analysis of high cost drivers to identify the underlying unit cost or utilization trends.
- Work with other departments to develop solutions and establish monitoring systems to determine the effectiveness of changes made.
- Prepare and present monthly IBNR analysis and reports.
- Complete required governmental reporting including rate development worksheets for Medi-Cal, Medicare bids, State health care cost reconciliations, and CMS annual MLR reporting.
- Assist in the development of health care budgets and forecasts.
- Conduct special analyses and projects at the direction of management for all lines of business as necessary
- Perform other duties as assigned.
Education and Experience: Bachelor’s degree in Economics, Finance, Accounting, or a related field. Minimum five (5) years of experience in healthcare financial analysis. Experience in Managed Care industry preferred.
Knowledge of: Principles and practices of financial management. Complex financial analyses. Methods of report preparation, writing and presentation. Statistical research, analysis and techniques. Governmental regulatory requirements. Healthcare industry data reporting standards, terminology, and guidelines. Medi-Cal and Medicare claims billing policies and procedure codes. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint.
Ability to: Work with relational database concepts and applications. Analyze and evaluate a variety of complex issues and recommend effective solutions; apply critical thinking and problem solving skills to complex analyses. Prepare clear and concise reports. Utilize computers and advanced computer software to analyze information. Communicate findings clearly and concisely in both a written format and in oral presentations. Communicate/Interact/work effectively with others. Achieve high degree of accuracy on all reports and analysis and possess excellent attention to detail. Work with minimal supervision while managing multiple tasks and meeting established deadlines. Understand key managed care functions and data complexities.
Compensation & Benefits
Starting Compensation Range: - depending on experience.
Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, STD, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more. Check out our full benefits package at: https://www.hpsm.org/abouthpsm/employment-opportunities.aspx (Under Employee Benefits Tab)
How to Apply
Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: firstname.lastname@example.org or via fax: (650) 616-8039. File by: Continuous until filled. EOE
Submissions without a Cover Letter and salary expectations may not be considered.