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- Reporting, Research & Analysis
- Analyzes and forecasts premium revenue, risk adjustment payments, and other revenue streams related to lines of business with minimal guidance.
- Interprets financial and enrollment data from internal and external sources, identifying opportunities and problems compared to anticipated outcomes.
- Evaluates financial data needs and identifies and implements solutions for program driving accurate coding and documentation to optimize revenue.
- Develops and maintains financial models to assess the impact of regulatory changes, enrollment trends, and market dynamics on revenue.
- Variance analysis: identify and explain variances between actual and projected revenue, providing actionable insights to leadership.
- Collaborates with actuarial, finance, compliance and operations teams to ensure accurate revenue recognition and reporting.
- Compliance & Documentation
- Ensure all revenue analysis and reporting adhere to internal policies and regulatory guidelines, and recommends strategic alternatives.
- Develops, maintains, and analyzes appropriate documentation of desktop procedures for reconciliation and audit needs.
- Builds and maintains in-depth knowledge of revenue structures and regulations and conceptual knowledge of related activities.
- Leadership & Continuous Improvement
- Recommends and implements process enhancements to improve the accuracy and efficiency of revenue analysis.
- Mentors junior analysts and may be assigned project lead requiring some resource planning assignments.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
#LI-Hybrid
Qualifications
- Bachelor's degree and five years of related experience; or an equivalent combination of education and related work experience.
- Strong presentation skills to peers, management and executive staff.
- Working knowledge of Medicare Advantage, Medicaid, and/or ACA revenue cycles for payers.
- Strong Working knowledge of claims, health plan financial data, and health industry structure.
- Advanced knowledge of Microsoft Office applications, including but not limited to Word, Excel, Outlook, and PowerPoint.
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