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Principal Financial Analyst (Decision Support)
Company | CalOptima |
Address | Orange, CA, United States |
Employment type | FULL_TIME |
Salary | |
Category | Hospitals and Health Care |
Expires | 2023-06-20 |
Posted at | 11 months ago |
Posted Date
- Develops medical expense, revenue and enrollment projections to support the budget process.
- Leads in the design, development, implementation and maintenance of report suites and dashboards for all levels of CalOptima Health management.
- Shares expert knowledge, mentors, trains and serves as a lead for analytical staff.
- Forms and leads ad-hoc teams on key initiatives.
- Provides clinical and utilization analysis to assist Medical Management with improving outcomes and quality of care for CalOptima Health members.
- Serves as a subject matter expert in the following areas: Medi-Cal provider rate methodology, Medicare provider rate methodology, Department of Health Care Services (DHCS) revenue, Centers for Medicare & Medicaid Services-Medicare Advantage (CMS-MA) revenue, population health member cohort identification, industry standard approaches to health care cost service categorization and metrics.
- Researches, assesses and develops advanced tools, models, reports and approaches to increase accuracy and timeliness of data-driven work projects.
- Collaborates with the Data Warehouse team to design and recommend improvements to the data warehouse.
- Develops financial models and reports to support provider contract negotiations.
- Completes other projects and duties as assigned.
- Provides expertise and analyses around risk adjustment.
- Develops return on investment and business case analyses for program initiatives under consideration by management.
- Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
- Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Bachelor's degree in Business Administration, Finance, Economics, Actuarial Sciences or related field required.
- An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
- 8 years of experience working with health care finance reporting and analytics required.
- 7 years of analytical experience working with Medi-Cal and/or Medicare payer information.
- Experience with risk adjustment concepts and familiarity with Hierarchical Condition Categories (HCC) and Chronic Illness and Disability Payment System (CDPS) models.
- Experience with DHCS rate development and/or Medicare Advantage bid process.
- Physical demands: While performing duties of job, employee may be required to move about the organization and to travel to offsite locations. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case while traveling, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting.
- Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures.
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