Qualifications

• Bachelor's degree plus five years of related experience, or equivalent combination of education and work experience.
• Strong presentation skills to communicate effectively with peers and executives.
• Working knowledge of Medicare Advantage, Medicaid, and ACA revenue cycles for payers.
• Strong understanding of claims processes, health plan financial data, and the health industry structure.
• Advanced proficiency in Microsoft Office applications, particularly Excel and PowerPoint.

Responsibilities

• Analyze and forecast premium revenue and risk adjustment payments with minimal guidance.
• Interpret financial and enrollment data to identify opportunities and issues compared to expectations.
• Evaluate data needs and implement solutions to optimize revenue through accurate coding and documentation.
• Develop financial models to assess impacts of regulatory changes and market dynamics on revenue.
• Perform variance analysis to clarify discrepancies between actual and projected revenue, providing insights to leadership.
• Collaborate with actuarial, finance, compliance, and operations teams for accurate revenue reporting.
• Ensure compliance with internal policies and maintain thorough documentation for auditing purposes.

Benefits

• Hybrid work environment allowing flexibility in work location.
• Opportunities for professional development and mentorship.
• Involvement in strategic decision-making impacting financial outcomes.
• Engagement with various departments providing a broad perspective on revenue generation.