Manager Provider Financial Analysis - Network Development Analytics

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Southfield, MI

Blue Cross Blue Shield of Michigan

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keywords: position summary,position details,consulting,analysis,performance,leadership,support,reporting,finance,risk management,knowledge,departmental preferences,knowledge,degree,experience,skills,management

Full-Time

Competitive Total Compensation Package

Overview: Responsible for the Provider Financial Analysis reporting team oversight, trend analysis and monitoring of the risk performance metrics, assistance in new risk arrangement modeling efforts, as well as coordination of the team in any budgetary/forecasting needs for the enterprise as it relates to the PPO or HMO risk arrangements. The Manager will also work with the Director of PFA in leading the implementation of the risk vendor tool (providing input on reporting needs, report structure, data mapping to appropriate cost categories, stop loss analysis, tool configuration, and UAT testing), reporting process development and documentation and ownership of report package generation and distribution.
Responsibilities: <ul> <li>Lead, implement, plan and monitor all departmental activities, including workflow; accountable for decisions made by staff with regard to providing financial analysis, reporting, and capitation.</li> <li>Use independent judgment to exercise authority on behalf of the company to recommend actions such as developing and/or assisting in budget preparation, staff training, and development, corporate policies and procedures, etc.</li> <li>Responsible for the PPO or HMO risk performance reporting function</li> <li>Responsible for preparation of supporting schedules and documentation related to budget/forecast development, BID submissions, and support of all enterprise audits of related risk arrangement financial performance (e.g. MLR, NCQA, HEDIS, CMS, FEHP, etc.)</li> <li>Reviews monthly/quarterly financial reports prepared by staff to understand the financial position of each Provider Organization and make recommendations for financial improvement.&nbsp; Review/approve supporting documentation and research to explain significant outcome variances.</li> <li>Coordinate with Provider Affairs and Contracting to incorporate financial analysis findings in future education and contracting processes.</li> <li>Direct the monthly capitation process ensuring that providers obtain accurate eligibility detail reports and capitation payments.</li> <li>Develop lines of communication to discuss/review results of the analysis to upper management via reports/presentations and assist leadership in implementing programs that provide solutions.</li> <li>Represent Provider Financial Analysis on committees relating to capitation and provider reporting; lead workgroups as necessary to achieve long and short-term goals.</li> </ul> <p>Departmental Preferences:</p> <p>Plan, forecast, monitor and evaluate department/corporate goals and objectives related to providing financial analysis and reporting, alternative capitation modeling and related reporting processes, annual capitation development, staff training, budgetary controls, staffing, workflow, and operational procedures.</p> <ul> <li>Lead, implement, plan and monitor all departmental activities, including workflow; accountable for decisions made by staff with regard to providing financial analysis, reporting, and capitation.</li> <li>Use independent judgment to exercise authority on behalf of the company to recommend actions such as developing and/or assisting in budget preparation, staff training, and development, corporate policies and procedures, etc...</li> <li>Coordinate with Provider Affairs and Contracting to incorporate financial analysis findings in future education and contracting processes.</li> <li>Direct the monthly capitation process ensuring that providers obtain accurate eligibility detail reports and capitation payments.</li> <li>Support communication and education of Provider Affairs staff and provider community as required.</li> <li>Ensure the accuracy and timeliness of the annual capitation rate changes to Facets.</li> <li>Represent Provider Financial Analysis on committees relating to capitation and provider reporting; lead workgroups as necessary to achieve long and short-term goals.</li> <li>Actively assist internal and external actuaries in the development and preparation of physician group capitation rates and management fund allocations on an annual basis; coordinate required analyses to support development.&nbsp;</li> <li>Excellent analytical, organizational, problem resolution, interpersonal, presentation, verbal, and written communication skills required.</li> <li>Knowledge of Facets and Business Objects preferred.</li> <li>Knowledge of HMO physician contracting, capitation process, provider accounting, and financial analysis required.</li> <li>Ability to perform complete system research/analysis and provider reasonable solution</li> <li>Basic knowledge of Microsoft Office Suite software (Word, Excel, Access, etc.) required.</li> <li>High degree of leadership, evaluative, analytical, and problem-solving skills required including problem-solving/operational skills required.</li> <li>Excellent organizational and prioritization skills with the ability to handle multiple projects and timelines required.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul>
Requirements: <ul> <li>Bachelor's Degree with a major in Accounting, Finance, Business Administration, Economics, Health Care Administration or other related field required.&nbsp;&nbsp;&nbsp;</li> <li>Six (6) years&rsquo; experience in accounting or financial analysis required including three (3) years dealing with health care industry reimbursement, physician risk arrangements and contracting.</li> <li>Two (2) years leadership experience required.</li> <li>Excellent presentation, verbal and written communication skills.</li> <li>Ability to manage multiple projects and to work with internal and external clients to identify needs and develop solutions.</li> <li>Knowledge of physician contracting, and capitation process required including provider accounting and financial analysis required.</li> <li>Advanced knowledge of Microsoft Office Suite software (Word, Excel, Access, etc.) required.</li> <li>Knowledge of Business Objects, SQL, SAS or related analytical reporting system preferred.</li> <li>High degree of leadership, evaluative, analytical and problem-solving skills required including problem solving/operational skills required.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul> <div id="gtx-trans" style="position: absolute; left: -204px; top: 26px;">&nbsp;</div>