What are the responsibilities and job description for the Managed Care Analyst position at Adventist Health?
Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Analyzes data and other information to support organization's strategic initiatives around risk-based healthcare arrangements. Measures and evaluates the financial performance of managed care capitation and risk arrangements across the System. Provides key financial, membership and utilization reports to System/Ministry leadership to provide insights into strategic business questions. Identifies areas of opportunity to improve performance of the System’s risk arrangements. Works on problems of moderate to diverse scope requiring some interpretation of policies and guidelines.
Job Requirements:
Education and Work Experience:
- Associate’s/Technical Degree or equivalent combination of education/related experience: Required
- Bachelor's Degree: Preferred
- Three years' technical experience: Preferred
Essential Functions:
- Prepares and posts monthly general ledger activity to the accounting system for all capitation arrangements across the System, including, but not limited to, premium revenue, stop-loss insurance, purchased services, incurred-but-not-reported (IBNR), administrative expenses and incentive-based revenue. Develops standard management reports to evaluate the financial and utilization performance of capitated arrangements.
- Calculates surplus/deficit settlement amounts for risk-sharing arrangements based on specific contractual provisions. Provides management and risk-sharing reports to executive System and Ministry leadership. Prepares and submits routine financial regulatory reports and assists in the facilitation of audits around regulatory and financial reporting. Coordinates the timely collection of monthly capitation premium payments and eligibility/revenue data from various payers.
- Analyzes membership data to ensure proper collection of payments and works directly with the payer to resolve discrepancies. Maintains a summary report that provides key membership and revenue details, including impacts from retro-activity and other manual adjustments. Organizes and maintains capitation contracts and agreements. Reviews existing/new contracts for financial implications and presents findings to management, ensuring proper inclusion within financial management reporting.
- Produces analytics by using business analytical/visualization systems to identify opportunities to improve performance when compared to budgeted Per-Month-Per-Member (PMPM) use rates and benchmarks. Documents and provides valuable insights to current claims trends which affect the movement of IBNR. Reports insights to financial management to provide context during the financial statement close process. Works with decisions that have moderate impact on function/family operations.
- Provides support to System/Ministry management, who routinely use/rely on capitation analytics and data in their job responsibilities, through preparation of ad-hoc utilization and financial reports. Validates the quality/accuracy of underlying data used for analysis and financial reporting. Assists with on-the-job skills training of associate analyst level roles.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.
