Sr. Financial Analyst (Medicare)

Description

While candidates from anywhere in California are welcome to apply, there is a strong preference for those who reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties). This role may offer opportunities for remote work; however, familiarity with and proximity to our local customers is valued.

Central Coast Salary Range: $117,904 - $176,857

Job Summary

We are seeking an experienced and analytical Sr. Financial Analyst to support Medicare Advantage (MA) financial operations, including revenue analysis, capitation payment reconciliations, CMS reporting, and preparation of internal financial reports and analysis. This role combines financial reporting, revenue integrity, budgeting/forecasting to ensure accuracy and strategic insights into our Medicare Advantage line of business.  The ideal candidate brings hands-on experience with CMS processes, healthcare finance systems, and advanced analytical capabilities to support enterprise decision-making and regulatory compliance.

Duties and Responsibilities

Responsible managing a team of Financial Analysts and the following job duties:

Key Responsibilities:

Medicare Advantage Revenue & Reconciliation:

• Analyze and reconcile Medicare Advantage and D-SNP revenue, including capitation, risk-adjusted payments (RAF), pharmacy rebates, Plan-to-Plan (P2P) transactions, and CMS reports (e.g., Plan Payment Reports, MMR, PDE).

• Reconcile enrollment and eligibility data from internal systems and CMS (MMR, Plan Pay Reports, Encounter data).

• Manage monthly CMS payment validation and flag discrepancies between actual vs. expected revenue.

Financial Reporting & Forecasting:

• Prepare internal financial analysis and reporting for Part C and D.

• Support budgeting and forecasting processes related to Medicare Advantage D-SNP product.

• Provide actionable insights into healthcare cost trends, premium revenue, medical expense ratios, and performance drivers.

• Assist in the development and reconciliation of annual CMS C/D bids with financial statements.

CMS Reporting & Compliance:

• Support the preparation and submission of required CMS financial and regulatory reports (MLR, DIR, PDE, P2P, Gap Discount).

• Maintain deep familiarity with CMS rules, including risk adjustment models (HCC/RAF), Star Ratings, and encounter data quality.

• Ensure timely and accurate supporting documentation for Accounting team, and internal controls in alignment with CMS guidelines.

Cross-Functional Collaboration & Audit Support:

• Partner with Accounting, Risk Adjustment, Operations, IT, and contracting teams to ensure accurate financial operations and seamless data exchange.

• Support the preparation of audit-ready reconciliations and schedules for internal and external reviews, including risk adjustment vendors and PBMs.

Operational & Systems Management:

• Maintain and analyze member enrollment by variables such as provider, county, age, gender, and RAF.

• Monitor and update MMR databases and Medicare Advantage membership tracking tools.

• Participate in process improvement activities and Medicare Advantage Projects

Qualifications

Knowledge/Skills/Abilities

Skills:

• Advanced Excel (pivot tables, VLOOKUP, modeling).

• Proficiency in ERP and financial reporting systems (e.g., Oracle, SAP, NetSuite, Hyperion).

• Familiarity with CMS reporting platforms, PBM systems, and healthcare financial databases.

• Strong analytical and problem-solving abilities.

Additional Attributes:

• Organized, detail oriented, and experienced in maintaining a complex reporting system required

• Ability to work in a fast-paced, dynamic environment with multiple priorities.

• A proactive approach to identifying opportunities for process improvements and financial efficiencies.

• Strong leadership qualities and the ability to collaborate effectively across departments.

• Must think independently and communicate effectively

Education and Experience

Education:

• Bachelor’s degree in Accounting, Finance, Economics, or related field. CPA, MBA, CMA, or CFA is a strong plus.

Experience:

• 5 years of progressive experience in healthcare finance, with a focus on Medicare Advantage.  D-SNP program experience a plus.

• Proven expertise in CMS MA payment methodologies, reconciliation, risk adjustment models (HCC/RAF), and capitation accounting.

Salary : $117,904 - $176,857