Henry Ford Health System Medicare Advantage Financial Analyst III - HAP Southfield in Southfield, Michigan
GENERAL SUMMARY: Under minimal supervision provide assistance to the Manager of the Medicare Advantage Risk Adjustment. Works closely with the Lead Medicare Advantage Financial Analyst in ensuring the finance responsibilities for the Medicare Advantage program are performed. Assists Lead tasks in the development and coordination of MA risk adjustment projects. Coordinate project start-up for chart review and Audits. Assist with HHS HCR RADV Audits as necessary. Assist with department control procedures, financial and reporting systems to provide specialized information to various users. Under minimal supervision perform analysis, reconciliation and problem solving, and understanding of the complexities of the Medicare Advantage program. Assist Lead in working with Henry Ford Medical Group, information systems, Membership & Billing departments and Altegra Health (Risk System). Coordinate system testing, enhancing data integrity, and work with internal as well as external customers to create and maintain the Medicare Advantage subsystems. Analyze department reports– identify data integrity issues, system and programming problems, and work with management to develop and implement improvement solutions. PRINCIPAL DUTIES AND RESPONSIBILITIES: *1. Coordinate and Support the development and coordination of Medicare Advantage projects that target members/providers for retrospective, prospective, and data validation projects for risk adjustment. This includes identification of suspects, creation of control reports and financial analysis of the projects. Coordinate work with HFHS, Network providers and multiple HAP departments. Develop solutions to emerging issue and problems related to managing projects. *2. Coordinate CMS RADV Audits and other external audits. Monitor the process and progress or file uploads to vendors and overall process as it relates to designing medical record chart chase list and oversees mailing of provider letters. *3. Assist Lead and coordinate new and changing initiatives as it relates to data management, reconciliation of data, and storage of data (including medical records) a file management both internally and externally. Assists with oversite of projects and works closely with IT, provider relations, HFMG and other inter-organizational departments to coordinate initiatives and projects as it relates to data retrieval, management, and storage for the department. *4. Maintains knowledge of Cognos, EDW, Altegra Risk view System and Facets. Assist with report development, verify membership, financial, and statistical data. *5. Support Altegra Health Risk View system through testing monthly load results, tracking open issues, testing Altegra system updates and identifying new system requests. Attend Altegra Health weekly and monthly meetings and monitor progress of Open Item list. *6. Provides key development and oversite of HFMG in Clinic visits. *7. Monitor CMS material and calls for required compliance and system or process changes. *8. Assist department manager in guiding support of analysts (MA FA I, II, and III) in performing routine assignments, ad-hoc projects and meeting established deadlines. Engage assistance of departmental support analysts in completion of required responsibilities where appropriate. *9. Provide support for Matrix (vendor) by attending regular meetings, addressing and monitoring IT issues and reconciling outstanding Matrix claims. Oversees the Matrix PCP Mismatch process, Matrix weekly invoice and mailing tracking as well as reconcile the loading of Health Risk Assessments (HRA) into Documentum and EPIC. *10. Routinely review and monitor the annual work plan to ensure that all projects are started and finished timely. Oversees team members (MA Financial Analysis I, II, and III) as needed. *11. Perform other related duties as assigned.
EDUCATION / EXPERIENCE REQUIRED:Bachelors degree in Health Care Administration, Information Systems, Accounting, Finance, or related field. Five (5) years of IT Data Management/Accounting/Finance/Managed Health Care Business related experience required.Two (2) years of experience developing, analyzing, interpreting, and trending data required.Experience leading and overseeing the work or other individuals on a regular basis with a positive outcome.Experience working multiple projects of a complex nature with proven success.Related and relevant experience or a demonstrated ability to perform the dutiesCompletion of Advanced Access, Excel, Cognos, GQL reporting and/or SQL training preferred.Experience / working knowledge of Cognos preferredExperience / working knowledge of EDW data warehouse or similar preferredExperience / working knowledge of Windows AccessHigh proficiency with Microsoft ExcelKnowledge of EDI processesKnowledge of Medicare processesProficient at using various data sources to develop relevant reporting tools, and to use those tools to enhance processes and proceduresGQL and/or SQL preferredKnowledge of accounting principlesKnowledge of business principles and functions ADDITIONAL SKILLS AND EXPERIENCE:Ability to work well under multiple pressure deadlinesStrong ability to be flexible in a changing environmentStrong leadership skills with ability to oversee and mentor team membersAbility to research, analyze, interpret, trend, and implement process improvement initiativesDemonstrated leadership and presentation skillsAbility to collect and prepare data for written/oral presentation - report creation and generationAbility to work effectively with all levels within the organizationExcellent written and verbal communication skillsProven problem solving and decision making skillsOverview Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health care systems, is a national leader in clinical care, research and education. The system includes the 1,200-member Henry Ford Medical Group, five hospitals, Health Alliance Plan (a health insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory network and many other health-related entities throughout southeast Michigan, providing a full continuum of care. In 2015, Henry Ford provided $299 million in uncompensated care. The health system also is a major economic driver in Michigan and employs more than 24,600 employees. Henry Ford is a 2011Malcolm Baldrige National Quality Award recipient. The health system is led by President and CEO Wright Lassiter III. To learn more, visitHenryFord.com. Benefits Whether it's offering a new medical option, helping you make healthier lifestyle choices or making the employee enrollment selection experience easier, it's all about choice. Henry Ford Health System has a new approach for its employee benefits program - My Choice Rewards. My Choice Rewards is a program as diverse as the people it serves. There are dozens of options for all of our employees including compensation, benefits, work/life balance and learning - options that enhance your career and add value to your personal life. As an employee you are provided access to Retirement Programs, an Employee Assistance Program (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other benefits and services. Equal Employment Opportunity/Affirmative Action Employer Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.