CalOptima
Lead Decision Support Analyst (Principal Financial Analyst)
CalOptima, Orange, California, United States, 92613
Overview
Lead Decision Support Analyst (Principal Financial Analyst)
at
CalOptima Health
is a senior analytics role responsible for highly complex analysis, guidance and expert knowledge on health care finance. The incumbent leads large-scale analytical initiatives, develops report suites and financial models to forecast medical cost trends, and serves as a subject matter expert to staff and consultants within the department. The role involves evaluating high-visibility issues, performing detailed analysis, and communicating thorough solutions to management. The position works with large amounts of claims, enrollment and provider data.
Duties & Responsibilities
95% - Financial Support
Participates in a mission-driven culture of high-quality performance with a member focus on customer service, consistency, dignity and accountability.
Assists the team in carrying out department responsibilities and collaborates to support short- and long-term goals/priorities.
Shares expert knowledge, mentors, trains and serves as a lead for analytical staff.
Serves as a subject matter expert in areas such as Medi-Cal provider rate methodology, Medicare provider rate methodology, DHCS revenue, CMS-MA revenue, population health member cohort identification, and health care cost service categorization and metrics.
Forms and leads ad-hoc teams on key initiatives and provides expertise and analyses around risk adjustment.
Leads in the design, development, implementation and maintenance of report suites and dashboards for CalOptima Health management.
Researches and develops advanced tools, models, reports and approaches to improve accuracy and timeliness of data-driven work.
Develops medical expense, revenue and enrollment projections to support the budget process.
Develops financial models and reports to support provider contract negotiations.
Develops ROI and business case analyses for program initiatives considered by management.
Provides clinical and utilization analysis to support improved outcomes and quality of care for members.
Collaborates with the Data Warehouse team to design and recommend improvements to the data warehouse.
5% - Other
Completes other projects and duties as assigned.
Minimum Qualifications
Bachelor's degree in business administration, finance, economics, actuarial sciences or related field plus 8 years of financial analysis experience in managed care or an equivalent combination of education and experience.
5 years of experience in Provider Contract Modeling, Provider Rate Analysis and/or Managed Care Contracting in a health care setting.
1 year of experience writing SQL.
Preferred Qualifications
5 years of analytical experience working with Medi-Cal and/or Medicare payer information.
Experience in an Independent Physician Association (IPA), hospital or health plan setting.
Intermediate to Advanced proficiency in Excel.
Experience with DHCS rate development and/or Medicare Advantage bid process.
Knowledge & Abilities
Develop rapport and establish effective working relationships with leadership, staff and external contacts at all levels.
Work independently and exercise sound judgment; communicate clearly in writing and orally.
Work a flexible schedule; available to participate in evening and weekend events.
Organize, analyze, problem-solve and manage projects; work well in a fast-paced environment.
Lead multi-program teams and external committees/coalitions.
Utilize Microsoft Office and job-specific applications to produce correspondence, charts, and reports.
Physical Requirements
Ability to read information on screens and printed materials; clear spoken communication; hearing for phone and in-person interactions.
Manual dexterity for typing and device operation; ability to sit for extended periods and lift/move objects up to 25 pounds.
Work Environment
Typically indoors and sedentary; travel as needed; environment may vary by location.
The noise level is usually moderate; conditions may vary by site (office, clinical, or remote).
EEO / Equal Opportunity : CalOptima Health is an equal opportunity employer. We prohibit unlawful discrimination based on race, religion, color, national origin, disability, age, sex, gender identity or expression, sexual orientation, veteran status, or other protected characteristics. Reasonable accommodations are available for qualified applicants with disabilities.
To apply, please visit: https://jobs.caloptima.org/jobs/lead-decision-support-analyst-principal-financial-analyst-505-city-parkway-west-california-united-states
#J-18808-Ljbffr
Lead Decision Support Analyst (Principal Financial Analyst)
at
CalOptima Health
is a senior analytics role responsible for highly complex analysis, guidance and expert knowledge on health care finance. The incumbent leads large-scale analytical initiatives, develops report suites and financial models to forecast medical cost trends, and serves as a subject matter expert to staff and consultants within the department. The role involves evaluating high-visibility issues, performing detailed analysis, and communicating thorough solutions to management. The position works with large amounts of claims, enrollment and provider data.
Duties & Responsibilities
95% - Financial Support
Participates in a mission-driven culture of high-quality performance with a member focus on customer service, consistency, dignity and accountability.
Assists the team in carrying out department responsibilities and collaborates to support short- and long-term goals/priorities.
Shares expert knowledge, mentors, trains and serves as a lead for analytical staff.
Serves as a subject matter expert in areas such as Medi-Cal provider rate methodology, Medicare provider rate methodology, DHCS revenue, CMS-MA revenue, population health member cohort identification, and health care cost service categorization and metrics.
Forms and leads ad-hoc teams on key initiatives and provides expertise and analyses around risk adjustment.
Leads in the design, development, implementation and maintenance of report suites and dashboards for CalOptima Health management.
Researches and develops advanced tools, models, reports and approaches to improve accuracy and timeliness of data-driven work.
Develops medical expense, revenue and enrollment projections to support the budget process.
Develops financial models and reports to support provider contract negotiations.
Develops ROI and business case analyses for program initiatives considered by management.
Provides clinical and utilization analysis to support improved outcomes and quality of care for members.
Collaborates with the Data Warehouse team to design and recommend improvements to the data warehouse.
5% - Other
Completes other projects and duties as assigned.
Minimum Qualifications
Bachelor's degree in business administration, finance, economics, actuarial sciences or related field plus 8 years of financial analysis experience in managed care or an equivalent combination of education and experience.
5 years of experience in Provider Contract Modeling, Provider Rate Analysis and/or Managed Care Contracting in a health care setting.
1 year of experience writing SQL.
Preferred Qualifications
5 years of analytical experience working with Medi-Cal and/or Medicare payer information.
Experience in an Independent Physician Association (IPA), hospital or health plan setting.
Intermediate to Advanced proficiency in Excel.
Experience with DHCS rate development and/or Medicare Advantage bid process.
Knowledge & Abilities
Develop rapport and establish effective working relationships with leadership, staff and external contacts at all levels.
Work independently and exercise sound judgment; communicate clearly in writing and orally.
Work a flexible schedule; available to participate in evening and weekend events.
Organize, analyze, problem-solve and manage projects; work well in a fast-paced environment.
Lead multi-program teams and external committees/coalitions.
Utilize Microsoft Office and job-specific applications to produce correspondence, charts, and reports.
Physical Requirements
Ability to read information on screens and printed materials; clear spoken communication; hearing for phone and in-person interactions.
Manual dexterity for typing and device operation; ability to sit for extended periods and lift/move objects up to 25 pounds.
Work Environment
Typically indoors and sedentary; travel as needed; environment may vary by location.
The noise level is usually moderate; conditions may vary by site (office, clinical, or remote).
EEO / Equal Opportunity : CalOptima Health is an equal opportunity employer. We prohibit unlawful discrimination based on race, religion, color, national origin, disability, age, sex, gender identity or expression, sexual orientation, veteran status, or other protected characteristics. Reasonable accommodations are available for qualified applicants with disabilities.
To apply, please visit: https://jobs.caloptima.org/jobs/lead-decision-support-analyst-principal-financial-analyst-505-city-parkway-west-california-united-states
#J-18808-Ljbffr