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Sr Medical Claims Analyst

To be fully engaged in providing No Harm / Quality, Customer Experience, and Stewardship by:

The Medical Expense Analyst, under general supervision of the Health Plan’s Accounting Manager, provides superior quality, competitive value and outstanding service and is primarily concerned with the analyzing and accounting for the medical expenses of Health First Health Plans, Inc. This position will be required to perform complex and detailed financial analysis of the medical expenses, and act in an advisory capacity; making recommendations to management. Additionally, this position will perform peer reviews of reconciliations, journal entries and other items, as directed by management.
•Maintain GL accounts related to medical expense by verifying data, analyzing trends, reconciling transactions, preparing journal entries and resolving all discrepancies.
•Complete account reconciliations of all Balance Sheet items related to medical expenses and pharmacy expenses/rebates.
•Regularly review the P&L, providing effective and timely feedback of the medical claims, including identifying and explaining all variances.
•Reconcile medical claims to core systems and identify the cause of any discrepancies.
• Assist in monitoring the month-end close process to ensure timeliness of tasks.
•Provide support in ensuring the timeliness and accuracy of audit PBCs

• Maintain the general ledger accounting and reconciliation of Health Plan’s medical claims.


• Maintain current information with respect to the accounting for medical expenses from GAAP and STAT perspectives, and communicate significant changes to appropriate personnel.


• Monitor PMPM for HFHP with the focus on identifying Key Drivers (as related to Medical Expenses and Pharmacy).


• Prepare medical claims reports for management and other departments, as required.


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Prepare Notes to the Financial Statements related to medical claims.



• Prepare the Shared Savings Agreement Reconciliation.


• Review large claims monthly estimate to Actuary.


• Review Statutory Supplemental Exhibits related to medical claims.


• Review account reconciliations, journal entries, reports and other work product as requested by management.


• This position requires IT system and financial understanding and how to accurately present subledger data from multiple Health First IT systems (Peoplesoft, AMISYS, & EPSI) cross walking to the general ledger.


• Collaborate with the Actuarial Department on medical expense topics.


• Assist various departments in the annual budgeting process through utilization of historical projections and upcoming changes.


• Prepare year-end audit schedules as required.


• Review contracts for compliance and financial implications.


• Respond timely and accurately to requests for information and reporting


• Participate in special projects as required.


• Responsible for meeting the HFHP close deadlines and milestones.


• Identify areas for efficiency improvements and provide Leadership with recommendations.


• Prepare financial statement account reconciliations of medical expenses that support audit requirements, internal budgeting needs, fiscal year, calendar year, line of business, and market segmentation.


• Utilize financial data analytics of medical expenses to provide information and recommendations to the Health Plans’ Leadership










Qualifications





QUALIFICATIONS REQUIRED:

•B.S. in business administration, finance, accounting, or related field, from an accredited college or university required. MBA or CPA desired.
•Minimum of five years of experience in general ledger accounting required.
•Minimum of three years of experience in a Health Plan or related medical field preferred.
•Minimum of three years of experience in financial analysis.
•Overall understanding of financial systems used by Health First, including the incoming and outgoing EDI transmissions of data, the posting of financial data between multiple computer systems, and the configuration tables within the computer systems.
•Prior experience and knowledge in the use of Peoplesoft preferred.
•Proficient in Microsoft Office products (SQL, Excel, PowerPoint, Word, Outlook)
•Time management and priority setting skills
•Possess excellent analytical and problem solving skills.
•Possess strong computer abilities and communication skills.
•Demonstrates the ability to relate well with all customers and peers.
•Ability to prioritize and organize to maximize quality, value, and service.




Job:Health First Health Plans (Health Insurance)

Organization:HF Administrative Plan Inc

Primary Location:United States-Florida - Brevard County-Rockledge


Schedule:Full-time

Shift Times:8:00 am - 5:00 pm

Job Level:Associate

Time:  Full time
Salary:  Hourly
Category:  Finance

Updated: 6/22/2018 8:14:10 AM