Senior (Financial) Data Analyst

Job Number: 2614

Workplace Type:

Position Title: Sr. Financial Data Analyst

External Description:

Sr. (Financial) Data Analyst

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

 

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast‐growing company, you will find ample room for growth and innovation alongside the Alignment community.

 

 

Position Summary:

 

The Sr. (Financial) Data Analyst will review, analyze and report on data from the Alignment Provider Management Report (APMR), 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. This will include the design and development of ad hoc reports to support Provider Contracting and Network Development, analysis of product line profitability, gross margin, and expansion market analytic support.

 

Another focus area will be creating, managing and distributing monthly, quarterly and annual risk pool exhibits to delegated entities/IPAs. This involves cross functional work with departments such as network management, claims, utilization management, provider configuration, IT, etc. in interpreting contracts, updating claims data to factor in exclusions for out of area services, transplants, etc. and assisting delegated entities as well as internal stakeholders in risk pool changes over time (identifying key drivers of risk pool surplus or deficits).

 

 

General Duties/Responsibilities:

 

(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

 

Making updates to risk pool calculations and definitions for new delegated entities, as well as during contract amendments for existing entities

 

Create, update, analyze and distribute monthly, quarterly and annual risk pool exhibits to internal stakeholders as well as delegated entities [FTP/SFTP‐File Transfer Protocol/Secure File Transfer Protocol)]

 

Analyze key drivers of risk pool surplus or deficits; communicate these drivers to internal stakeholders

 

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 Requirements:

 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

1. Minimum Experience:

 

1. Experience in financial analysis and working with data, preferably working with healthcare data, either from educational study or professional experience

 

1. At least a foundational level of knowledge of Access, SQL and/or other database programs

 

1. At least an intermediate level of proficiency with MS Excel (Pivot tables, VLOOKUP, etc.)

1. Education/Licensure:

 

1. Bachelor’s Degree in Engineering, Logistics, Data Analytics plus 5 years of progressive experience in Data Analytics in healthcare. In lieu of experience, will accept a Master’s Degree in Logistics or Business Intelligence and Analytics. Will accept foreign degree equivalencies. Certification in Data Analytics such as Tableau, Epic required.

 

 

1. Other:

 

1. Knowledge of risk pools preferred (hospital funding, claims exclusions based on Division of Financial Responsibility (DOFRs) , surplus and deficit carry‐overs, etc.)

 

1. Knowledge of principles and practices of finance administration in accounting, budgeting, and auditing.

 

1. Understanding of CMS (Center for Medicare and Medicaid Services) Premium payment methodologies to MA Health Plans. Understanding MMR (Monthly Membership Report) documentation, premium payment calculations, Risk Adjustment Factors (RAF), other premium adjustments, and file layout.

 

1. Understanding of CMS provider payment methodologies such as Diagnosis Related Group(DRG) Resource Based Relative Value Scale (RBRVS)

 

1. Understanding of operations, services and activities within a Data Warehouse environment (Claim Data, Membership, Eligibility, and Revenue Data, etc.)
2. Understanding provider capitation contracts, development of capitation rates, contract carve outs, performed comparative analysis to Fee For Service.

 

1. Exposure and ability to use Actuarial studies related to IBNR (Incurred But Not Reported) and LDS (Limited Data Set)
2. Understanding of provider contracts for medical groups, independent physicians, and hospitals.

 

1. Understanding of payment methodologies for Hospitals (DRG (Diagnosis Related Group), Per Diem, % of Billed, etc.) and Physicians (RBRVS (Resource Based Relative Value Scale), FFS (Fee for Service) , Capitation, etc.) and other ancillary providers.
2. Develop new analysis and approaches to the use of data that allow fresh insights into the business of the company

 

1. Work Environment
   1. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

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.

 

1. 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.

 

 

1. 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.

City: Remote-Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Senior (Financial) Data Analyst

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].