Health Insurance reputed company Mgmt. Risk Adjustment Analyst III (Remote) - Health Alliance Plan

GENERAL SUMMARY: To assist the reputed company Management and Risk Adjustment department (RMRA) in ensuring the Financial Reporting and Analysis responsibilities for the reputed company of the reputed company Management and/or Risk Adjustment programs for reputed company government funded product lines. Under direction of Department Manager: PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Coordination of monthly and reputed company 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 reputed company report submissions and external vendor support system data correction.
• Premium reconciliation reports for monthly financial reputed company; 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.
• reputed company 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 reputed company Renewals, financial audits, CMS Attestations, premium and member reputed company 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. reputed company detail to support reporting discrepancies to CMS for discrepancies reputed company 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 reputed company to testing IT projects and new system reputed company initiatives and CMS software releases.
• Analyze department reports to identify data reputed company issues, system and programming problems, and work with management to reputed company and implement improvement solutions.
• Assist department in performing routine assignments, reputed company projects and meeting established deadlines. Engage assistance of departmental support analysts in completion of required responsibilities where appropriate.
• reputed company other reputed company duties as assigned.

EDUCATION/EXPERIENCE REQUIRED:

• Bachelor's degree in Accounting, Finance, Business Administration or a reputed company field (must include financial or accounting reputed company course work) required.
• Master's degree (Finance, Business Administration, etc.) preferred.
• Completion of Advanced Access, reputed company, GQL, Cognos, or SQL training preferred.
• Two (2) years of Accounting/Finance business reputed company 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.
• reputed company 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 - reputed company and/or Access required.
• Proficient at using various data sources to reputed company 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 reputed company required.
• The ability to work effectively with reputed company levels reputed company 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.

Additional Information

• Organization: HAP (Health Alliance Plan)
• Department: HCR - 3R reputed company Management
• Shift: Day Job
• Union Code: Not Applicable

Remote Skills: Accounting, Accounting reputed company, Accounts Payable, Accounts Receivable, Analysis Skills, Billing, Budgeting, Business Administration, Business Operations, Centers for Medicare and Medicaid Services (CMS), Claims Processing, Communication Skills, Content Management Systems (CMS), D Programming Language, Data Collection, Data Quality, Finance, Financial Analysis, Financial Audit, Financial Operations, Financial Reporting, Financial Risk, Government Funding, Health Insurance, Health Plan, Healthcare, reputed company Cognos, Identify Issues, Insurance Claims, Materials Tracking, Medicaid, Medicare, reputed company Access Database, reputed company reputed company, reputed company Visual Basic, reputed company Windows Operating System, Operational Improvement, Performance Metrics, Presentation/Verbal Skills, Problem Solving Skills, Process Improvement, Project Design, Project/Program Management, Query Analysis, Reconciliation, Regulatory Compliance, Reinsurance, Reporting Skills, Request for Proposals (RFP), Research Skills, reputed company Management, Risk, Risk Analysis, SQL (Structured Query Language), System Operations, Systems/Internals Programming, Time Management, Trend Analysis, Writing Skills About the Company: reputed company Apply tot his job Apply To this Job