The Financial Analyst II for Capitation is responsible for accurate monthly capitated payments reconciliations, reporting and analysis. Incumbents may analyze workflows and processes and institute new workflows and processes or make improvements to existing to achieve greater efficiency.
This is a full-time remote position. The successful candidate must reside in North Carolina.
Responsibilities & Duties
Analyze and Reconcile Capitation payments
Ensure TBI and Innovations Accounts Receivable (A/R) accuracy by tracking updated information contained in subsequent monthly report data from the State and Alliance Slot Tracking Reports
Update TBI and Innovations reconciliations as necessary with rate changes or discrepancies
Attend weekly meetings with the State to resolve Capitation Reconciliation discrepancies should tickets be submitted
Track and organize State changes in the PMPM rates overtime and make changes to other dependencies
Complete reconciliations for capitated payment arrangements with subcontractors based on Alliance membership, contract agreements and submitted invoices
Complete Reports and monitor trends
Complete A/R, Liability, Accrual and Capitated Payment reports used by accounting at month end close including Medicaid AR, Risk Reserve and any other adhoc requests necessary with rate changes
Complete the Monthly Membership Model using capitated payment data utilizing SQL
Submit State Capitation Reconciliation monthly reports
Complete hardship payment requests and payment plan details
Complete monthly Medicaid and TCM trend analysis report for review by management
Monitor trends for any unusual changes or increased/decreased growth
Identify and drivers of variances and present findings
Develop new KPI's or insights into trend behaviors
Develop and Implement Processes, workflows, and reporting
Aid in development of processes for new vendor/subcontractors and complete related new desk procedures
Create desk procedures for other processes and workflows
Recognize areas that can be improved upon and establish new reporting that would be insightful and impactful for decision makers
Innovate workflows to create a more sustainable and accurate process that can be repeated and documented
Collaborate with departments and sub-contractors to resolve member issues
Responsible for assisting other units in resolving member errors or issues blocking capitated payments and access to services
Liaise with subcontractors on capitated payment arrangements
Minimum Requirements
Education & Experience
Associates Degree in Business Administration, Finance, Public Policy, Hospital Administration, or related field and at least five (5) years of related experience in financial analysis with demonstrated capacity to independently draw inferences and to communicate findings or an equivalent combination of education and experience.
Or
Bachelor's Degree in Business Administration, Finance, Public Policy, Hospital Administration, or related field and at least three (3) years of related experience in financial analysis with demonstrated capacity to independently draw inferences and to communicate findings or an equivalent combination of education and experience.
Additional Training Preferred:
A background in managed healthcare, insurance operations preferred
Knowledge Skills & Abilities
Thorough knowledge of financial data analysis methodology, including the use of evaluation techniques and problem-solving procedure
Advanced skills with Microsoft products, particularly Excel
Ability to resolve complex problems that require the evaluation of alternative methods and solutions
Ability to work independently
Ability to set objectives an prioritize workflows
Ability to prepare concise and accurate reports
Strong written and verbal communication skills
Ability to work under pressure and meet established deadlines
Able to quickly learn the financial systems and applications used in the organization
Ability to utilize SQL
Salary Range
$66,240 - $84,456/Annually
Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.
An excellent fringe benefit package accompanies the salary, which includes:
Medical, Dental, Vision, Life, Long and Short-Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave
Dress flexibility
