AR Capitation Revenue Analyst

Amerihealth Caritas Health Plan Philadelphia , PA 19107

Posted 6 months ago

Responsibilities

Under the general supervision of the Manager, Accounts Receivable, the Analyst is responsible for the continued enhancement of the capitation/membership revenue cycle process through the improvement and completion of existing state mandated reporting requirements while maintaining a high level of accuracy, integrity and timeliness of data reports.

  • Completes monthly reconciliation between State Payment & Membership Eligibility. Generate and review reporting to ensure accuracy and alignment with all Plan and State reporting requirements assigned.

  • Be fluent with existing and new State contracts and guides, and system notices.Advise management on needed actions to comply with state requirements as they occur.

  • Prepare, analyze & interpret monthly reporting to identify Financial Trends and/or anomalies. Researches, tests and validates results. Provides explanations for variances and changes.

  • Develops and maintains strong knowledge of business practices, claims coding and the managed care industry in general and applies knowledge to determining data and report solutions.

  • Ability to work on multiple tasks with competing priorities; demonstrates strong subject matter expertise in the states and business processes that they support

  • Assist with onsite audit requests as it relates to the Reconciliation Process.

  • Solid analytical skills and problem solving skills with the ability to articulate and communicate recommendations for enhancement.

  • Maintains and creates databases, queries, joins, tables and forms; designs and creates SQL stored procedures, technical specifications and user-defined functions, writing functional and technical specification documents.

Experience and education:

  • One to three years' experience Data Analysis, Data Warehousing, understanding translated EDI files, financial reporting, electronic remittance advice (codes) and related financial analysis experience

  • Proficient in MS Office applications including Access, Excel, Outlook, and SQL Server Management Studio.

  • Strong working knowledge of business computer programs, applications and systems, database structures and data files required.

  • Understanding of clinical coding or claims processing preferred.

  • Two years' experience in healthcare finance and/or financial reporting, preferred

  • Strong communication (both written and verbal), analytical and problem solving skills

  • Strong organizational skills with ability to coordinate several projects simultaneously

  • Ability to work on multiple tasks with competing priorities; demonstrates strong subject matter expertise in the states and business processes that they support

  • Ability to work accurately and independently as well as comfortable interacting collaboratively with all levels of business; open mind to consider alternative ideas and next steps for remediation.

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AR Capitation Revenue Analyst

Amerihealth Caritas Health Plan