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Job Description
Summary:
The Hospital Risk Pool Financial Analyst leads the preparation and delivery of financial, clinical, and business analysis. This includes the accurate quantification and measurement of clinical outcomes. Key responsibilities include overseeing and developing operating plans and financial solutions that promote effective decision-making, revenue enhancement, cost efficiency, and sound business practices. The candidate will work closely with hospital teams to develop and package financial products and reports tailored to meet the needs of MPM customers. The analyst ensures the timely delivery of quality financial reports to MPM clients. This role acts as a key liaison between Hospital Operations and Finance leadership, fostering a forward-focused environment of "no surprises".
Duties and Responsibilities
- Obtain and review hospital capitation detail and summary reports monthly.
- Run paid claims reports monthly and/or quarterly to calculate claims costs.
- Run lag reports for claims paid and received.
- Calculate/update IBNR models using lag reports and other methodologies.
- Prepare Risk Pool summaries by health plan, line of business, and aid category.
- Prepare combined health plan Risk Pool summaries.
- Prepare capitation summaries by health plan, line of business, and aid category.
- Prepare reports of claims by month and service type.
- Distribute reports to hospital clients and MSO Financial Analysts.
- Maintain daily cash flow and monthly bank reconciliations.
- Prepare and submit additional requested reports.
- Prepare end-of-month financial and board packages.
- Conduct ad-hoc financial analyses as requested.
- Automate data mining for Risk Pool reporting.
- Develop and validate SQL queries for data extraction.
- Create ad hoc reports to respond to management inquiries.
- Assess and document business operations for data integrity and process optimization.
- Analyze hospital financial risk pools to understand performance factors.
- Identify issues requiring investigation, validate discrepancies, and coordinate with departments.
- Prepare regular and ad hoc reports for internal and client use, including joint operations meetings.
- Respond to inquiries related to hospital client needs.
- Optimize reporting efficiency.
Minimum Job Requirements
- Bachelors degree in Accounting/Finance or equivalent experience.
- 3+ years experience in Physician Organization, Health Plan, or Hospital Finance.
- Understanding of provider and health plan contracting, risk delineation, medical terminology, and reimbursement methodologies.
- Proficiency in SQL, Microsoft Access, Excel, PowerBi.
Knowledge, Skills, and Abilities
- Advanced Excel, PowerPoint, and MS Office skills.
- Strong analytical skills and finance knowledge.
- Effective communication, accuracy, and deadline management.
- Interpersonal skills for effective relationships.
- Ability to work independently and in teams.
- Detail-oriented with proofreading skills.
- Quick learner of new concepts.
- Professionalism and confidentiality, including HIPAA compliance.
- Strong SQL Server skills, including query tuning and data extraction.
- Experience creating PowerBI reports and using Power Query for data processing.
Working Conditions
- Reliable attendance.
- Office environment.
- Minimal physical effort and risk.
Additional Details
- Seniority level: Mid-Senior level
- Employment type: Full-time
- Job function: Finance and Sales
- Industry: Medical Practices
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