Sr. Financial Analyst

Royal Health Care is a leading health care management services company located in midtown Manhattan. We have an immediate opening for a Senior Financial Analyst in the Finance Department.

Position Overview:

The major areas of responsibility include:Analysis and reporting of medical costsAnalysis and reporting of hospital, provider/ PCP, and vendor performanceAnalysis of enrollment demographics and premium incomeAnalysis and tracking of all billing sourcesTracking of maternity and newborn claims and reconciliation with billed kicksInvestigation, analysis and rebilling of all premium and kick denialsSpecial Projects

 

Duties and Responsibilities:



This position interfaces with all levels of management, professional staff and clients. Strong verbal communication skills are essential.





Analysis and reporting of medical costs for Medicaid, Family Health Plus, Child Health Plus and Medicare lines of business. Analysis must encompass utilization rates and unit costs for both in-network and out-of-network services. Analyses by tier code, risk pool and category of service are also required. Prepare of reports for internal management use that present comparative data and highlight significant trends are required. Analyses are to be completed at least quarterly.





Analysis and reporting of all medical costs/ utilization by entity (ie - owner hospital, provider/PCP, vendor, etc). Identify high utilizing entities and perform all ad-hoc analysis/ drilldowns.





Analysis of enrollment characteristics to identify changes in member mix and related implications on medical costs and revenue. Develop reports as necessary to track enrollment changes by line of business, tier code, etc.





Monitoring and analysis of all billing and receivables discrepancies. Identify opportunities for revenue recovery as necessary.





Track all hospital birth and maternity claims and subsequent billing/ collection of newborn birth and maternity kick payments. Analyze all discrepancies between claims and kick payments.





Investigate, analyze and rebill all denied premiums and newborn/ maternity kick payments.



Develop reporting tools in SAS, Access and Excel as needed to perform the required analyses.Special projects that require data analysis and reporting can arise at any time in any area of medical cost or revenue analysis. Additional assistance may be needed with premium/ kick billing activities.

 

Qualifications



A solid understanding of both health plan operations and the operations of a management services organization ("MSO").



Experience in one or more of the following areas: NY State Medicaid/ FHP/ CHP government programs, Medicare, Commercial, or other health insurance plan experience.



Must be very well organized to be able to understand, analyze, interpret, transform and summarize large amounts of complex data into straightforward and meaningful management reports. Reports must be clear and concise for use by executive management.



Strong verbal communication and presentation skills are required.



Proficiency in Excel, Access and SAS and/or other data analysis and reporting tools is essential to high performance in this position.



Ability to work independently or in a team as necessary.



The ability to research and develop an understanding of the changing environment for government managed care programs is essential.



A graduate or undergraduate degree(s) in accounting, finance, actuarial science, public administration or public health is expected. Three to five years of experience in a health plan environment with increasing responsibility is required.