A prestigious medical group in the Anaheim area is seeking a talented Managed Care Finance Manager to join their organization. The responsibilities for the Managed Care Finance Manager are below:
Understanding of and experience with how revenue is derived in Medicare, how risk adjustment ties in, how risk adjustment activities occur within CMS, and midyear and final scores cutoff period on claims encounters
Pull data with SQL, such as claims and capitation data, to build risk pool statements
Mitigate and resolve issues found, such as data quality or completeness issues
Understanding of agreement structure and what actual charges are
Keep track of various financial pieces of contracts, deadlines, and timelines
Keep track of settlements and if externals are following through on payments
Ability to produce standard reports, and also act quickly on ad-hoc requests from leadership
Ability to be team-oriented and collaborate with the existing team and other depts
Pull data, build automation, work with large data sets, and make sense of how to join and compare disparate tables and bridge different data sets
Experienced professional/manager with risk pool finance and analytics
Experience in the medical group or MSO setting preferred
Perform and oversee healthcare analytics regarding risk pools and managed care contracting
Pull and extract data from Epic to perform various analytics
Conduct analysis and modeling on population health, quality, full risk, and partial risk managed care operations, UM (utilization mgmt.), CM (care mgmt)
Determine the effectiveness of health plan and provider contracts and evaluate impacts on costs
Determine recommendations for achieving financial goals and budgetary targets for managed care results.
Provide analysis as needed for strategic planning, budgeting, and forecasting, validation reports, standardized databases
Develop analytical reports to assist in improving utilization
May support other areas of financial plans, budgets, and support for month-end review of financial statements
Ability to collaborate with other depts/teams, communicate effectively, and present to leadership
Systems: Excel, Epic Tapestry
Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half puts you in the best position to succeed by advocating on your behalf and promoting you to employers. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity – even on the go. Download the Robert Half app and get 1-tap apply, instant notifications for AI-matched jobs, and more.
Questions? Call your local office at ~~~. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals. Visit ~~~/ for more information.
Come join a rock solid, growing organization that values customers, community and employees. Recently, People’s United Bank was ranked #1...Apply For This Job
Job Description Nottingham School District Business Administrator/Finance Manager After a full year of planning for the transition from SAU 44...Apply For This Job
Job Description Job Details What You Will Do : The Senior Finance Director, Transformation is responsible for demonstrating disciplined delivery...Apply For This Job
Job Description Our Future Leaders Programme will ignite the leader in you. This unique programme is designed to develop Unilever’s...Apply For This Job
job description Signup on Hired to get in front of real hiring managers for your next Account Executive (remote work...Apply For This Job
job description ACCOUNTING CLERK– MONDAY THROUGH FRIDAY – FULL TIME – STILLWATER, MN Who We Are Summit Management owns and...Apply For This Job