• Premium Revenue – coordinate efforts across region with similar lines of businesses to ensure consistent processes for managing premium revenue including MLTSS revenue management and appropriate risk adjustment. Review and analyze premium rates within the region for appropriateness. Develop analysis and arguments to support rate negotiations with the states within the region.
• Rate Advocacy – collaborate with Vice President of Policy & Planning and Vice President of Government Contracts to ensure a consistent message to policy makers on rate development as applicable. Review and analyze financial terms of provider agreements and rate development to provide recommended changes.
• Quality Improvement Activities – provide region support for provider report card/performance monitoring activities with regard to quality, pay for performance, and clinical performance measurements.
• Medical Management – develop and standardize approach to manage medical expenses. Collaborate with Chief Medical Officer and Vice President of Program Operations for Healthcare Services to improve medical management efficiency and identify/implement profit improvement initiatives across the region.
• Administrative Efficiencies – standardize productivity measures for routine processing activities. Collaborate with Chief Medical Officer, National Medical Director, Vice President of Program Operations for Healthcare Services and Chief Operating Officer to establish standard metrics included in staffing models and identify opportunities for improvement. Review and analyze regional administrative costs.
• Budget/Forecast – monitor actual to budget/forecast performance. Identify and implement appropriate responses to variances. Corporate Medical Informatics – work with corporate to support reporting, financial performance, common metrics and formatting and increase quality in all healthcare data analytical activities. Coordinate activities with corporate to avoid duplication of work.
• Finance Function – represent Finance by participating on committees and multidisciplinary teams as needed.
• Encounter Reconciliation – standardize activities across the region to ensure all encounters are successfully submitted and errors are resolved. Ensure the encounter process fully supports rate development, collection of case rate payments and maximize risk scores while complying with State guidelines.
BA, BS, in Finance, Accounting, or related field; Advanced training or experience in healthcare analytics
• 15 years progressive healthcare finance or analytical experience.
• 5+ years managed care/Medicaid experience.
• 10+ year's previous supervisory/management experience.
MBA, MS in Finance, Accounting, or post graduate training in finance
• 15+ years of accounting