Senior Manager, Medicare Financial Analysis
Location
Camarillo, CA | United States
Job description
The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.
Gold Coast Health Plan will not sponsor applicants for work visas Work Culture:
GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This enables us to create the health plan of the future and do our best work –Together.
GCHP allows a flexible work environment so employees can work from a home location or in the office for all or part of their regular workweek (see disclaimer).
GCHP’s focuses on our 5 Core Values:
• Integrity
• Accountability
• Collaboration
• Trust
• Respect
Disclaimers:
• Flexible work schedule is based on job duties, department, organization, or business need.
• Gold Coast Health Plan will not sponsor applicants for work visas.
POSITION SUMMARY
The purpose of this position is to direct and provide oversight to the Finance team in supporting the organization’s financial and strategic initiatives through complex financial analysis and financial reporting. The position is responsible for the development of complex financial analysis, financial models and financial reporting to support program, policy, and strategic plan initiatives.
Key responsibilities of this positions include:
• Function as lead on Medicare implementation, applying subject matter expertise to develop required regulatory financial oversight and reporting, assist with Bid development, partner with Controller on development of accounting, develop Commission payment functionality, and lead development of financial analysis.
• Facilitates decision-making by providing actionable financial analysis.
• Direct involvement in the development of new financial analytics and financial data reporting projects that will help drive more efficient business decisions.
• Proactively works as a data steward on behalf of the Finance team which includes establishing/documenting/maintaining definitions of financial data sets and working collaboratively with IT in developing specific access procedures and reporting requirements for financial data sets and other recurring reporting deliverables.
• Provides leadership and coaching to Finance team staff and communicate financial and business results in a clear, concise, and easily understood way in both written and verbal communication forms.
ESSENTIAL FUNCTIONS
Reasonable Accommodations Statement
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.
Essential Functions Statement(s)
• Provides leadership and direction in Medicare financial analysis and financial reporting for the Finance team.
• Manages, hires, trains, and develops staff within area of Medicare financial analysis and reporting.
• Provides direction and guidance for financial analysis staff in performing their duties in accordance with established departmental and organizational policies.
• Analyzes actual performance against budget and other data to identify, evaluate and communicate drivers of performance.
• Assists with the preparation of monthly, quarterly, and annual financial statements by providing variance analysis to management and Commission reporting packages.
• Responsible for revenue analyses; including monitoring and calculating the impact of risk scores and Star scores.
• Prepares monthly Incurred But Not Paid (IBNP) medical expense reserves, maintaining IBNP estimation model, and using business insights and other research to explain fluctuations in claims reserves.
• Analyzes GCHP's health care costs and works with other departments to explain changes in cost and cost trends (focusing on clinical utilization, cost profile and other indicators for all areas of medical costs).
• Manages the data collection, completion of and submission of Medi-Cal rate development templates (RDT), supplemental data requests (SDR) and other financial reporting requirements to the CA Department of Health Care Services (DHCS) or other external reporting agencies.
• Supports the annual budget and interim forecasts with a focus on membership, revenue, and medical expenses.
• Contributes to the evaluation of decision support and analysis tools and collaborates on the development of Business Intelligence reports/dashboards/databases, financial models, and promotes other innovative approaches to increase accuracy and timeliness of data driven financial analysis projects.
• Adapts financial analysis and reporting to meet the growing and changing needs of the Health Plan.
• Participates in special cross-functional projects and assignments as needed to support financial reporting and analysis.
• Presents methodologies, concepts, and results to all levels of management.
• Assists Chief Financial Officer and Finance Team as necessary in other analytical projects and duties as assigned.
POSITION QUALIFICATIONS
Competency Statement(s)
• Management Skills - Ability to organize and direct oneself and effectively supervise others.
• Business Acumen - Ability to grasp and understand business concepts and issues.
• Decision Making - Ability to make critical decisions while following company procedures.
• Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.
• Interpersonal - Ability to get along well with a variety of personalities and individuals.
• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
• Time Management - Ability to utilize the available time to organize and complete work within given deadlines.
• Consensus Building - Ability to bring about group solidarity to achieve a goal.
• Relationship Building - Ability to effectively build relationships with customers and co-workers.
• Presentation Skills - Ability to effectively present information publicly.
• Delegating Responsibility - Ability to allocate authority and/or task responsibility to appropriate people.
• Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.
• Strategic Planning - Ability to develop a vision for the future and create a culture in which the long-range goals can be achieved.
• Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.
• Judgment - The ability to formulate a sound decision using the available information.
• Communication, Oral - Ability to communicate effectively with others using the spoken word.
• Communication, Written - Ability to communicate in writing clearly and concisely.
• Problem Solving - Ability to find a solution for or to deal proactively with work-related problems
SKILLS & ABILITIES:
Education: Bachelor's Degree Required, Field of Study: Finance, Accounting, Business, Economics, Healthcare, or a related field
Experience: 10 plus years of progressive experience in Medicare financial management and analysis.
Minimum 5 years’ experience with Medicare D-SNP managed care: Required.
Experience with Medi-Cal managed care: Preferred.
Computer Skills:
Strong working knowledge and experience with Microsoft Office products (Advanced Excel- Lookups, SumIfs, pivot tables, data management)
Knowledge of business intelligence tools and experience with PowerBI and Milliman MedInsight: Preferred.
Knowledge of relational databases and MS SQL Query tools experience a plus but not required
Other Requirements:
Ability to work in a team environment, take and give directions and follow through with tasks and projects.
Excellent analytical, problem-solving and research ability.
Experience in report/analytics development preferred.
Techniques and methods in preparing forecasts, projections, and financial models.
Knowledge of principles and practices of managed health care industry and strategies, provider contracting, IBNR, pricing and rate setting, claims, provider network structures and risk sharing arrangements.
Understanding of how to measure and monitor medical utilization and unit cost trends associated with managed care operations.
Must have strong verbal and written communication and developed presentation skills.
Certifications & Licenses: A valid and current Driver's License and Auto Insurance
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