The Operations Analyst assists the Financial Planning & Analysis department in all areas of financial analysis with regard to the Company, its financial solvency, its cash flow, its various regulatory reporting obligations, its ongoing as well as new business relationships, and its overall financial performance.
General Duties/Responsibilities (May include but are not limited to):
Assist with implementation of new expansion markets (reporting, system configuration, business processes, etc.).
Prepares monthly PCP capitation reports for direct contracted providers, IPA in the new expansion markets.
Review and validate "Alignment Provider Management Report" (APMR) internal system reporting data (revenue, capitation, supplemental JSA, claims, pharmacy, etc.);
Maintain IPA/ Hospital/ Supplemental contract types, effective dates, percentages/ PMPM's for APMR system configuration.
Reviews monthly and annual capitation analysis, reconciliations and disbursements to IPA's, reinsurance providers and ancillary medical service providers.
Review allocation of monthly revenue and expense by state and county to support the Accounting Department journal entries into Great Plains.
Review and validate "Provider Data Management" (PDM) implementation of new contract configuration setup in EZ-Member cap rate table. Assists with annual budget, bid preparation, and prepare network development rate modeling and analysis.
Supports Director and VP of Financial Planning & Analysis on all regulatory audits for CMS, the Department of Managed Healthcare, state, and federal taxing authorities, etc.
Prepares and tracks IPA financial solvency for all affiliated risk-bearing organizations ("RBO's") to present and distribute to management team.
Monitor affiliated risk-bearing organizations submission of financial statements quarterly & annual within 45 days from the end of the RBO fiscal year.
Reviews DMHC's notifications in regards to Corrective Action Plans (CAP) for existing IPA's with whom the Company transacts business;
Prepares various membership, revenue, and cost analyses by county for the Director and VP of Financial Planning & Analysis on both a monthly and ad-hoc basis.
Acts as a liaison to the Information Technology Department for the creation of various database queries on utilization, membership, revenue sources, etc.
Develops and updates policies and procedures (including desktop procedures) for functional areas such as capitation, late enrollment penalties, LICS, etc.
Reports annual membership metrics to regulatory agencies (e.g. - DMHC) on all risk bearing organizations ("RBO's") with whom the Company transacts business.
Reviews monthly and annual Plan-to-Plan ("P2P") reconciliations for amounts payable to (and receivable from) other health plans.
Prepares and reconciles quarterly amounts received by (and due to) the Company with respect to the Coverage Gap Discount Program including follow up of payment discrepancies.
Other special projects as assigned.
Supervisory Requirements:
This position is highly visible and interacts with all levels of the organization - including Executive Management. Although this position does not directly supervise staff, it is responsible for managing project timelines and deliverables from various areas of the Company.
Minimum Requirements:
3 years of relevant finance experience
Healthcare experience preferred
Education/Licensure:
Bachelor's degree in a finance or equivalent work experience
Other:
Advanced knowledge of Excel
Excellent communication and interpersonal skills
An ability to explain financial matters in writing
Language Skills: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Mathematical Skills: Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Reasoning Skills: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Computer Skills: At least an intermediate to advanced level of proficiency with MS Excel.
Other Skills and Abilities:
Good organization skills; ability to handle multiple assignments simultaneously.
Good analytical skills.
Good interpersonal skills in a business setting.
Good business writing skills.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
