Job description

Job Summary:

This position will analyze financial and health information to support business decision making on the healthcare revenue, cost, and outcomes. The position will monitor claims cost; identify revenue opportunities such as claims overpayment, leakage claims and billable services; monitor PCP and specialty cap; prepare risk pool and incentive summaries; prepare journal entries; and assist in risk pool and capitation auditing. Additionally, this position will summarize financial results from various system reports.

Skills and Abilities:

1. High level computer skills such as Excel and Access Database. SQL preferred.
2. Position requires an understanding of the business unit’s/organization’s goals and operations.

3. Strong documentation, organization, and follow up skills.

4. Strong analytical, multi-tasking, and problem solving skills.

Physical Requirements:

1. Ability to sit, stand, stoop, reach, lift (up to 10 pounds), bend, etc., hand and wrist dexterity to utilize computer.

2. May require travel to attend meetings.

Environmental Conditions Critical to Performance:

1. Work is in an office environment, climate controlled through central air conditioning.

2. May have some exposure to outside environments while traveling.

Education and Experience:

1. Bachelor’s degree in accounting, finance, business, or other related areas.
2. At least 1-2 years of financial analysis and database reporting experience.

3. Experience with database and data analysis technology. SQL, EZ Cap, Cognos, or Crystal Reports experience is a plus.

JOB DESCRIPTION

Essential Job Functions of Job Description:

1. Essential Job Functions of Job Description
2. Generate monthly claims analysis to identify high-cost specialties. Provide trend for claims age and payment turnaround time.
3. Identify revenue opportunities, such as claims overpayment, leakage claims, and billable services.
4. Summarize financial results from various system reports.
5. Conduct financial analysis and prepare financial reports.
6. Audit health plan capitation report and make sure the rates are according to the health plan contracts. Compare capitation yield to the budget.
7. Submit monthly stop loss report.
8. Summarize risk pool and incentive performance.
9. Assist in risk pool auditing.
10. Maintain schedules, worksheets, and other documentation to support journal entries included in financial statements.
11. Perform special analysis on utilization and/or cost reports.
12. Communicate through formal means such as e-mails or memos when important matters require action from others. Follow up on such matters. Resolve open items promptly.
13. Produce ongoing reports as necessary to support business unit needs.
14. Perform other duties as assigned.

Job Type: Full-time

Pay: $60,000.00 - $100,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Relocation assistance
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift

Ability to commute/relocate:

• Montebello, CA 90640: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Financial analysis: 2 years (Required)

Work Location: Hybrid remote in Montebello, CA 90640

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