Senior State Sponsored Program Revenue & Reconciliation Analyst

Advantagecare Physicians New York , NY 10007

Posted 3 months ago

The Senior State Sponsored Program Revenue & Reconciliation Analyst supports the Billing Revenue Manager with the State Sponsored Program Revenue and Reconciliation in executing systems solutions to business needs for the Medicaid/HARP/Nursing Home revenue integrity team. Such business applications include: premium payment reconciliations. Manage a portfolio of an annual amount of $1B per year. Provide direction to others on the resolution for the collection of outstanding dollars. Act as the liaison with the State on audits and premium reconciliations.

Responsibilities:

  • Implement procedures and programs that will optimize revenue opportunities ensuring that Emblem receives the maximum payments for each Medicaid/HARP and Essential Plan member. Reconcile the membership data with the State, ensuring the proper capitation reimbursement is received Establish and maintain KPIs and metrics for monitoring and reporting to Senior Leadership.

  • Direct timely and accurate responses to OMIG Audits, working across the organization for required information, recommend necessary changes to enrollment or revenue records and bring to resolution; Establish collaborative partnerships to evaluate and address billing/payment audit issues on an ongoing basis, and develops and leads completion of work plans.

  • Manage and coordinate the premium audits with the State. Provide oversight to CTS, partnering with the vendor, to create the outbound reconciliation files, review State Responses, identify trends establish next steps Provide guidance to the vendor on proper processing Track the resolution of outstanding dollars.

  • Participate in the State Technical Calls, capture business requirements and changes related to enrollment and billing. Develop test plans, coordinate user acceptance testing and ensure quality controls are followed.

  • Identifies and evaluates emerging compliance risks, utilizing regulatory guidance, resources, and data analytics on an ongoing basis to implement leading billing compliance practices.

Qualifications:

  • Bachelor's degree is required

  • Minimum 4 6 years' experience directly related business background

  • Related system knowledge in SAS, ACCESS and EXCEL is required

Additional Information

  • Requisition ID: 180001EC
icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Revenue Analytics Senior Analyst

ION Media Networks

Posted 2 weeks ago

VIEW JOBS 10/3/2019 12:00:00 AM 2020-01-01T00:00 Overview The Senior Analyst, Revenue Analytics is responsible for supporting the Commercial organization in strategically analyzing inventory, pricing, maximizing revenue and optimizing commercial operations. This individual will work with Sales, Inventory Management and Yield teams with the goal of ensuring that the most efficient and effective financial decisions are made. Responsibilities * Support the pricing and revenue strategy and analytics for advertising. * Responsible for revenue reporting, dashboards and analyses. * Create new approaches to pricing and processes using data and science. * Input and evaluate advertising deals for adherence to company pricing and inventory guidelines. * Analyze and communicate with sales, inventory management, finance and executive management to highlight revenue trends and opportunities to optimize revenue. * Lead process and systems improvement initiatives within Commercial Operations and related departments. * Apply proficiency in financial analysis, data mining, and quantitative analysis to see beyond the data in identifying and quantifying high-impact opportunities. Qualifications * 3+ years of experience in Finance or Analytics. * Alternate experience in the field of Revenue / Yield / Inventory Management, Pricing, * Bachelors or an advanced degree in a quantitative discipline such as engineering, math, or finance. * Significant experience in data mining, modeling, analysis and reporting. * Advanced Microsoft Excel experience with the ability to navigate large data sets is a must. * Extremely organized and able to work proactively to manage all assigned projects. * Demonstrates a systematic approach towards collecting data from various sources. * Strong analytical, mathematical, problem-solving and time-management skills. * Familiarity in SQL-like query languages and statistical analysis (SAS, R or Python) is a plus. ION Media Networks New York NY

Senior State Sponsored Program Revenue & Reconciliation Analyst

Advantagecare Physicians