Revenue Mgmt. Risk Adjustment Analyst III (Hybrid/Troy, MI) - Health Alliance Plan
GENERAL SUMMARY:
To assist the Revenue Management and Risk Adjustment department (RMRA) in ensuring the Financial Reporting and Analysis responsibilities for the oversight of the Revenue Management and/or Risk Adjustment programs for all government funded product lines. Under direction of Department Manager:
PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Coordination of monthly and ad hoc data submissions, monitoring data for accurate tracking and reporting of medical, drug claim data and membership data to CMS RAPS, EDPS and DDPS and Edge Server. Produce, distribute, monthly, quarterly, and annual key performance indicators (KPI’s) and error/rejection detail for all report submissions and external vendor support system data correction.
- Premium reconciliation reports for monthly financial close; file payment issues with CMS and monitor response; monitor MMR accruals; estimate risk adjustment premium impact for final reconciliation with CMS; allocation of premium to at-risk provider networks.
- Maintenance of the following queries and analysis: Reconciliation reports for Risk Adjustment, Reinsurance, Risk Corridors, APTC, Cost Sharing, and Part D program receivables and payables for monthly accounting needs. Monitor accruals for final reconciliation with CMS and cost sharing.
- Develop and enhance reporting capabilities for financial and operational performance.
- Annual financial reporting activities including CMS bid filings, HCR Premium Development, RFP on financial Risk Adjustment projects, Employer Group Rate Renewals, financial audits, CMS Attestations, premium and member revenue budgets, Medical Loss Ratio reporting.
- Produce reports to provide M&B discrepancies in the premium payments from CMS. Team with Membership & Billing staff to identify and resolve enrollment, claims, provider and premium discrepancies. Develop detail to support reporting discrepancies to CMS for discrepancies outside of M&B’s influence.
- Monitor CMS material and calls for required compliance and system or process changes. Work with management on design and implementation of the changes.
- Development and maintenance of departmental policies and procedures for audit purposes and support department in adhering to HAP Compliance department requirements. Complete routine monitoring of departmental procedures and documentation to demonstrate internal (MAR) and external (CMS) audit readiness.
- Coordinate and assigns tasks related to testing IT projects and new system related initiatives and CMS software releases.
- Analyze department reports to identify data integrity issues, system and programming problems, and work with management to develop and implement improvement solutions.
- Assist department in performing routine assignments, ad-hoc projects and meeting established deadlines. Engage assistance of departmental support analysts in completion of required responsibilities where appropriate.
- Perform other related duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor’s degree in Accounting, Finance, Business Administration or a related field (must include financial or accounting related course work) required.
- Master’s degree (Finance, Business Administration, etc.) preferred.
- Completion of Advanced Access, Excel, GQL, Cognos, or SQL training preferred.
- Two (2) years of Accounting/Finance business related experience required.
- Two (2) years managing projects and initiatives designed to improve business operations required.
- Three to five (3-5) years of experience developing, analyzing, interpreting & trending data preferred.
- Experience with Medicare Advantage, Medicare Part D, Medicaid or Qualified Health Plans preferred.
- Experience in health care finance preferred.
- Affordable Care Act (ACA) experience or knowledge preferred.
- Knowledge of HAP’s Core system operations and functionality preferred.
- Knowledge of business principles and functions required.
- Proficient knowledge of Windows – Excel and/or Access required.
- Proficient at using various data sources to develop relevant reporting tools, and to use those tools to enhance processes and procedures required.
- Knowledge of accounting and financial reporting principles and business functions required.
- Ability to research, analyze, interpret, trend, and implement process improvement initiatives required.
- Ability to collect and prepare data for written/oral presentation – report creation and generation required.
- The ability to work effectively with all levels within the organization required.
- Excellent written and verbal communication skills required.
- Well defined problem solving and decision making skills required.
- Knowledge of Facets or other Health Insurance Claims/Membership systems preferred.
- Knowledge of Medicare and/or Medicare Advantage processes preferred.
- Visual Basic preferred.
- Experience with Cognos, SQL Developer, GQL reporting tools preferred.
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, Â Â Â Â Â companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
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Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s Â
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Â Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. Â My Choice Rewards is a program as diverse as the people it serves. Â There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. Â As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services. Employee's classified as contingent status are not eligible for benefits
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.