Senior Financial Analyst, Capitation

Recruiter
L.A. Care Health Plan
Location
Los Angeles
Salary
Competitive
Posted
19 Jan 2019
Closes
02 Feb 2019
Contract type
Permanent
Hours
Full time
Job Summary

The Senior Financial Analyst is responsible for the monthly management of financial activity including various capitation payments and/or Shared Risk Analysis, provider incentives, claims analysis, journal entry preparation, account analysis, month–end reconciliations and preparation of financial reporting tools for contracted Participating Provider Groups(PPG) for all product lines of business. Interfaces and serves as liaison with multiple departments.

Duties

Responsible for preparation and analysis of multiple types of provider capitation payments and incentive payments. Prepare accurate and timely analysis and reports for the contracted PPGs. Adjustments made within specified time limits outlined in regulatory SB260 guidelines.

Responsible for the auditing functions needed to produce a reconciled, Shared Risk analysis.? Involves monitoring claims activity, DFOR review, reconciling Shared Risk contributions and providing Quarterly and annual settlement statements.? Ensure receivables are?? netted according to contractual arrangements.? Ensure all CCS and Stop Loss? recoveries are accurately and timely reported.

Prepare Journal Entries and perform related General Ledger Account analysis and reconciliation of both Shared Risk, Incentives and capitation databases.?

Generate monthly financial reporting tools for capitation, Shared Risk expense and medical costs for all lines of business.

Prepare and participate in the completion of all assigned special projects.

Practice proper data management.

Perform other duties as assigned.

Education

Associate's Degree or Bachelor's Degree in Business or Finance

Bachelor's Degree in Business or Finance

Experience

Required
With Bachelor's Degree:? 3–5 years experience in a healthcare setting (HMO and IPA), extensive knowledge of capitation and/or shared risk and demonstrated ability to work with complex databases.

For Capitation:? Experience in Calculation of Provider's Capitation.

For ShareRisk: Experience in reconsiling risk pools to claims experience.

Preferred:
With? Master's Degree:? 2 years experience in a healthcare setting (HMO and IPA), extensive knowledge of capitation and/or shared risk and demonstrated ability to work with complex databases.

Equivalent Experience:
With Associate's Degree:? 5 years experience in a healthcare setting (HMO and IPA), extensive knowledge of capitation and/or shared risk and demonstrated ability to work with complex databases.

With High School Diploma/GED:? 6–8 years experience in a healthcare setting (HMO and IPA), extensive knowledge of capitation and/or shared risk and demonstrated ability to work with complex databases.