Purpose Statement / Position Summary The Managed Care Analyst, Senior (MCA-S) supports senior management by preparing advanced reports and analysis from internal data sources. As a liaison with other departments, the MCA-S ensures that Finance department needs are being addressed and met. The MCA-S is an independent worker and performs the necessary collection and analysis of data to address questions from senior management and individuals outside the organization. Key traits of this position are: strong analytical skills, highly motivated, utilizes conventional and unconventional methods to solve problems and takes ownership of issues.
Essential Job Outcomes
Depending on reporting area(s) assigned, some or all of the following:
Monthly institutional cost reports are prepared accurately and in accordance with established deadlines. A thorough and insightful analysis is completed with little to no direction from supervisor.
Health plan data/reports are carefully reviewed and a detailed analysis is prepared, which identifies trends in revenue, PMPM and adjustments. Analysis is thorough and completed timely with little to no direction from supervisor.
IBNR model is created in accordance with established deadlines and a detailed analysis is completed which identifies trends in data and includes recommendations to management on appropriate reserves. This is completed with little to no direction from supervisor.
Medical cost, utilization and physician trend reports are designed and presented to leadership in accordance with established deadlines and include a thorough and insightful analysis of trends. They are completed with little to no direction from supervisor.
Monthly reports and payments to contracted providers are prepared accurately and timely and include a thorough analysis of payment fluctuations. Inquiries from providers and leadership regarding payments and reports are addressed quickly and accurately. The report preparation and inquiries are handled with little to no direction from supervisor.
By-healthplan financial statements are prepared and thoroughly analyzed in accordance with established deadlines with minimal to no direction from supervisor.
Ad hoc reports are created in accordance with communicated expectations and include a thorough, insightful analysis and are completed with little to no direction from supervisor.
Collaborations with Business Intelligence department, health plans, Network Management department, etc. to strategize and design databases and queries are productive and achieve desired results.
Presentations to senior leadership are thorough, yet succinct, clearly address issues and exhibit professionalism and tact.
Proactively and independently identifies anomalies in data. Prepares and presents appropriate, actionable data and recommendations to leadership.
“Other duties as assigned”
Proficient in Access and Excel, as well as other MS Office products.
Minimum 5 years’ experience, preferably in healthcare or managed care.
Experience using relational databases, decision support systems, analysis and modeling.
High school diploma or equivalent
Bachelor’s degree in Finance or Healthcare
Training in RDBs, SQL, Access and Excel required
Microsoft Office Specialist Certification or above preferred.
Internal Number: MEM003308
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