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Posted : Thursday, September 21, 2023 08:34 PM
JOB DESCRIPTION
Your Role
The Managed Care Finance team administers the financial terms and conditions of our capitated contracts with IPA/Medical Groups, Hospitals, and Vendors.
The Financial Analyst, Experienced will report to the Manager of Managed Care Finance.
In this role you will be performing provider contract analysis, financial research, preparing financial forecasts, analyzing data trends, and translating data into useful information.
You will interact with a variety of internal units as well as IPA/Medical Groups to monitor financial payments and reporting to ensure compliance with contractual requirements and governmental regulations.
Your Work In this role, you will: Analyze limited raw revenue/expense data and summarize detailed revenue/expense data; compare summarized claim data against fee schedules and contracts Assist with production of contract performance reports, modeling of reimbursement rates, evaluation of financial contract modifications and compiling and monitoring key managed care statistics Participate in the development of financial models; collect and evaluate data, analyze results Perform daily cash desk activities (e.
g.
, account review, funds movement, daily reporting, near-term forecasting) Follow and conduct audit processes and review internal controls to ensure financial transactions are accurate, timely and comply with accounting standards, principles and company policy Generate reporting and provide analysis of capitation, eligibility, membership, shared risk arrangements, claims, and provider incentive programs Develop financial accruals and prepare payments for expenses related to retroactive capitation rate increases, shared risk settlements, provider incentives, provider claims, and other non-standard contract provisions Provide contract interpretation consultation (including non-standard contracts) to internal business units and external provider customers Assist in the development of new processes and reporting mechanisms to meet company needs and improve customer service Address and/or resolve non-standard customer issues and builds strong relationships with customers QUALIFICATIONS Your Knowledge and Experience Requires a bachelor's degree or equivalent experience Requires at least 3 years of prior relevant experience Exposure to health care related membership, capitation, claims processing systems, and/or provider contracting is desired Knowledge of the functions and responsibilities of other units within a health insurance company and familiarity with the health insurance industry is desired Requires the ability to use computers and related software applications including MS Access and/or Excel Ability to debug, modify, and enhance existing Access databases and Excel macros and develop new applications in MS Access and/or Excel for automated processes and data manipulation is desired Requires the ability to read, analyze and interpret non-standard provider contracts, technical procedures, and governmental regulations Pay Range: The pay range for this role is $71,280.
00 to $99,770.
00 for California.
Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade.
Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
ABOUT THE TEAM Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price.
We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve.
Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving.
Here at Blue Shield, we strive to make a positive change across our industry and communities – join us! Our Values: Honest .
We hold ourselves to the highest ethical and integrity standards.
We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
Human .
We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
Courageous .
We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model: Blue Shield of California is dedicated to making work-life balance a reality.
Whether you prefer to work in an office or from home, we understand flexibility is more important than ever.
That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.
Two ways of working: Hybrid (our default) and office Hybrid – In a business unit approved office a few times per year to 3 days per week, on average Office – In a business unit approved office 4+ days a week, on average.
If the role you’re applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.
Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment.
Due to the current public health emergency in California, Blue Shield employees are almost all working remotely.
Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Equal Employment Opportunity: External hires must pass a background check/drug screen.
Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance.
All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
The Financial Analyst, Experienced will report to the Manager of Managed Care Finance.
In this role you will be performing provider contract analysis, financial research, preparing financial forecasts, analyzing data trends, and translating data into useful information.
You will interact with a variety of internal units as well as IPA/Medical Groups to monitor financial payments and reporting to ensure compliance with contractual requirements and governmental regulations.
Your Work In this role, you will: Analyze limited raw revenue/expense data and summarize detailed revenue/expense data; compare summarized claim data against fee schedules and contracts Assist with production of contract performance reports, modeling of reimbursement rates, evaluation of financial contract modifications and compiling and monitoring key managed care statistics Participate in the development of financial models; collect and evaluate data, analyze results Perform daily cash desk activities (e.
g.
, account review, funds movement, daily reporting, near-term forecasting) Follow and conduct audit processes and review internal controls to ensure financial transactions are accurate, timely and comply with accounting standards, principles and company policy Generate reporting and provide analysis of capitation, eligibility, membership, shared risk arrangements, claims, and provider incentive programs Develop financial accruals and prepare payments for expenses related to retroactive capitation rate increases, shared risk settlements, provider incentives, provider claims, and other non-standard contract provisions Provide contract interpretation consultation (including non-standard contracts) to internal business units and external provider customers Assist in the development of new processes and reporting mechanisms to meet company needs and improve customer service Address and/or resolve non-standard customer issues and builds strong relationships with customers QUALIFICATIONS Your Knowledge and Experience Requires a bachelor's degree or equivalent experience Requires at least 3 years of prior relevant experience Exposure to health care related membership, capitation, claims processing systems, and/or provider contracting is desired Knowledge of the functions and responsibilities of other units within a health insurance company and familiarity with the health insurance industry is desired Requires the ability to use computers and related software applications including MS Access and/or Excel Ability to debug, modify, and enhance existing Access databases and Excel macros and develop new applications in MS Access and/or Excel for automated processes and data manipulation is desired Requires the ability to read, analyze and interpret non-standard provider contracts, technical procedures, and governmental regulations Pay Range: The pay range for this role is $71,280.
00 to $99,770.
00 for California.
Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade.
Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
ABOUT THE TEAM Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price.
We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve.
Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving.
Here at Blue Shield, we strive to make a positive change across our industry and communities – join us! Our Values: Honest .
We hold ourselves to the highest ethical and integrity standards.
We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
Human .
We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
Courageous .
We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model: Blue Shield of California is dedicated to making work-life balance a reality.
Whether you prefer to work in an office or from home, we understand flexibility is more important than ever.
That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.
Two ways of working: Hybrid (our default) and office Hybrid – In a business unit approved office a few times per year to 3 days per week, on average Office – In a business unit approved office 4+ days a week, on average.
If the role you’re applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.
Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment.
Due to the current public health emergency in California, Blue Shield employees are almost all working remotely.
Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Equal Employment Opportunity: External hires must pass a background check/drug screen.
Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance.
All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
• Phone : NA
• Location : Oakland, CA
• Post ID: 9156273745
