Manager of Financial Data and Analysis (Neighborhood Health Plan of Rhode Island.; Providence, Rhode Island): Reporting to the Director of Analysis & Medical Expense Management, this position is responsible for developing, implementing, maintaining, monitoring and overseeing the organization's financial reconciliation initiatives for Medicaid, Medicare and Commercial products. This position works with varied stakeholders. Responsibilities include:
Financial Data Reconciliation:
- Support department objectives through financial and pricing modeling, financial data analysis, reconciliation and reporting.
- Create and maintain financial reconciliation process for Medicaid, Expansion, Unity, Integrity and commercial products.
- Perform detailed Commercial data financial reconciliation programs on quarterly basis to ensure annual completion of EDGE Server and financial reconciliation for MLR, Edge Server Risk Adjustment Reporting and other CMSrequiredreporting.
- Implement and maintain financial reconciliation processes between Encounter Data Processing System (EDPS), Risk Adjustment Payment System (RAPS) and Supplemental files for complete CMS mandated submissions. Also, build and support CMS and State required Encounter data RiskSharing Settlement process for Medicare by providing financial data reporting and maintaining reconciliation programs.
- Develop and maintain State mandated Rate Setting reconciliation and RiskShare reconciliation processes and reports for Medicaid, Expansion, Unity and Integrity products.
- Responsible for timely submission of Rate Setting and RiskSharereports each annually to State with ad-hoc analysis support.
- Perform as the data expert to monitor and analyze the effectiveness of risk adjustment programs, processes, infrastructure, and reporting, and make changes to improve results and effectiveness.
- Provide annual data reporting for Risk Adjustment Data Validation (RADV) audits in conjunction with Risk Adjustment team and Auditors.
- Provide baseline reporting to CMS quarterly and financial data reporting to State as per requirements for Commercial and Medicare products.
- Provide internal reporting for revenue recognition, risk score optimization, and submitted diagnosis data accuracy as per risk score management process.
- Validate the supplemental files accuracy against the claims processed in the system.
- Create and maintain pricing of benefit components for Exchange Commercial product based on network agreements and composition.
- Risk Corridor Gain/Share, Risk/Reward reporting for Medicare services performed annually.
- Accomplish contractual reporting requirement by updating reconciliation programs as per annual requirements by CMS and State. Financial Data Submission Oversight and Quality Assurance: Collaborate with internal departments to ensure data quality and data integrity maintenance for State encounter data financial reconciliation.
- General Management: Engage in on-going performance management of staff including coaching, mentoring, development, training, and succession planning to include hiring and termination decisions.
Minimum requirements: Master's degree in Information Systems, Business Administration, or Healthcare Administration and 2 years of business, financial, or data analysis experience in the managed care or healthcare industry. Alternate requirements for this position are a Bachelor's degree in Information Systems, Business Administration, or Healthcare Administration and 5 years of business, financial, or data analysis experience in the managed care or healthcare industry.
Must have: (1) Direct or indirect supervisory, mentoring and coaching experience and experience mentoring and coaching analysts; (2) Experience in financialreporting and requirements and in gathering requirements from the client or business and documenting requirements; (3) Experience managing projects and process flows of projects; (4) Intermediate level of proficiency with SAS or SQL programming; and (5) Advanced skills in Microsoft Office including Project, Word, Excel, PowerPoint, Outlook; and (6) Demonstrated effective written and verbal communication skills.
Req No. 2017-7636