Manager, Healthcare Economics
Location: Orange, California US
Job Number: 1746
Position Title: Manager, Healthcare Economics
As a Healthcare Economics Manager within Alignment, you will analyze data, create models and reports to measure clinical outcomes, network performance, analyze product line profitability, gross margin, and expansion market analytic support, using the Alignment Provider Management Report (APMR), as well as other available data sources, which includes but is not limited to medical claims data, utilization data, pharmacy data and other sources such as general ledger postings, accounting data, etc. The Manager of Health Plan Economics will also supervise, review and manage the development and implementation of the Alignment Provider Management Report (APMR). You will present your findings and recommendations to broad audiences in a clear and concise manner.
(May include but are not limited to)
- Develop and manage Alignment Provider Management Report (APMR) for current and expansion markets.
- Work with Alignment IT department to assist in the programming and mapping of various financial and key performance indicators within APMR
- Work with Alignment Accounting staff to reconcile and verify the integrity of APMR yearly and monthly financial data to the General Ledger
- Work with Alignment FP&A team to incorporate budget data and assumptions into APMR.
- Work with Alignment Claims department to validate the integrity of claim payment within APMR
- Work with Alignment Provider Contracting and Network Development staff to analyze contract rate trending impact and anomalies.
- Work with Alignment UM and Clinical operations department to validate and reconcile key authorization admit and bed day metrics to actual paid claim data.
- Support Regional VP’s in providing analysis of monthly APMR data and ad hoc reporting of key performance indicators.
- Support finance and operations in developing predictive KPI’s to better forecast and manage the business of Alignment.
- Work with all levels of staff to direct, assist, and explain the APMR process as needed.
- Reading, interpreting and clarifying delegated entity/IPA contracts with regards to risk pool definitions for revenue, expense, carve outs and calculations
- Demonstrate commitment and attendance sufficient to complete the duties of the position as required.
- Perform related duties similar to the above in scope and function as required.
- Minimum Experience:
- 2+ experience in financial analysis and working with data, preferably working with healthcare data, either from educational study or professional experience
- At least a foundational level of knowledge of Access, SQL and/or other database programs
- At least an intermediate level of proficiency with MS Excel (Pivot tables, VLOOKUP, etc.)
- Bachelor of Science or equivalent work experience
- Healthcare experience preferred.
- Managerial experience preferred
- Knowledge of principles and practices of finance administration in accounting, budgeting, and auditing.
- Understanding of CMS Premium payment methodologies to MA Health Plans and Risk adjustment Factors (RAF), other premium adjustments, and file layout.
- Understanding of CMS provider payment methodologies (DRG, RBRVS, etc.)
- Understanding of operations, services and activities within a Data Warehouse environment (Claim Data, Membership, Eligibility, and Revenue Data, etc.)
- Understanding provider capitation contracts, development of capitation rates, contract carve outs, performed comparative analysis to Fee For Service.
- Understanding of provider contracts for medical groups, independent physicians, and hospitals.
- Be able to work to goals with low level of supervision
- Communicate clearly and concisely, both orally and in writing.
- Establish and maintain effective working relationships with those contacted in the course of work.
- Maintain effective audio-visual discrimination and perception needed for making observations; communicating with others; reading and writing; and operating assigned equipment.
- Maintain mental capacity which allows the capability of making sound decisions and demonstrating intellectual capabilities.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
- The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Location City: Orange
Location State: California
Community / Marketing Title: Manager, Healthcare Economics
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.