At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. MemorialCare stands for excellence in Healthcare. Across our family of medical centers and physician groups, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.
Under the direction of the Director of Population Health Analytics and the Executive Director ACO, the ACO Analyst for the ACO Department is responsible for providing analysis for the Accountable Care Organization (ACO) or other defined Value Based Initiatives / alternate payment arrangements. This position is responsible for successful preparation and analysis of timely and accurate monthly reporting of the ACO’s key metrics, financial position, quarterly & annual reporting. This role will provide support and network-wide accountable care financial performance analysis to deliver results against population cost targets and quality measures for covered populations. The ACO Analyst is required to understand and apply knowledge of health care reform, managed care contracting and historical and cutting edge reimbursement methods to generate complex, customized analysis and research deliverables. These deliverables are used for key decision making with material financial and clinical implications. The incumbent must be proactive in identifying issues and opportunities to enhance data management and reporting capabilities and is responsible for both detailed and high-level problem solving. He or she will focus on data analysis, database development and management, data extraction and reporting from various internal and external systems.
Essential Functions and Responsibilities of the Job * Manage a large set of data (some are raw flat file data), develop and adopt progressive models for reporting and reconciliation. Review data, generate concise reports, interpret results from analysis / reports and make actionable recommendations to non-financial / non-technical audience. Using a triple aim approach and deliver results to clinical operational and financial audiences. * Analyze quarterly and annual reports and financial statements from various payers including projection, reconciliation, trends, and research outliers / patterns. * Create monthly report packages and other performance metrics (i.e. Visibility Board, Management Summaries) to distribute to the various business operations including monthly cost analysis to identify high cost areas. * Analyzes monthly payer reports. * Ability to complete work independently and collaborate with internal and external team members and participate in ACO and/or related meetings, committees or functions. * Able to design and implement dashboard reports according to business requirements and technical specifications including generating charts and graphs that foster an understanding of actionable opportunities. * Excellent interpersonal communication (one-on-one and group) and customer service with ability to work both independently and as part of a team. * Strong analytical skills, with a proven ability to develop and document resolution of complex issues and understand and display unwarranted variation and trend analysis, examine irregularities in data. * Extremely organized, self-motivated individual able to handle fluctuating volumes of work, able to prioritize work to meet deadlines. This includes estimation of effort, time management and develop realistic timelines for projects and tasks. * Automate / enhance processes using technical skills. * Work with mathematical concepts such as probability and statistical inference to apply concepts to actionable recommendations for ACO Clinical Case Managers / Coordinators, medical staff and leadership. * Utilizes benchmarking data to evaluate current processes as they are related to operations. * Prepares forecasts based on current reimbursement trends and information gathered from internal / external sources. * Work with external actuary on (and/or possibly provide) actuarial analysis including but not limited to forecasting, pricing, reserving (IBNR unpaid claim cost estimates), trending, valuation, variance and risk management from multiple data sources. * Ability to be a liaison within the MemorialCare business segments and external partners and/or vendor for analysis of actuarial, financial, utilization and cost to Produce deep dive analysis to facilitate understanding of medical cost levels and trends and facilitate strategy development. * Research and analyze historical revenue and cost data to project budget for the next fiscal year. * Develop, maintain and distribute ad-hoc reports and financial models as needed.
* A minimum of 2 years relevant experience. * Working knowledge of different healthcare reimbursement methodologies, including per diems, fee schedules, case rates, discounts, capitation, DRGs and others. * Demonstrated experience working with relational databases, decision support systems, analysis, and statistics, forecasting and modeling, BI tools and basic to intermediate knowledge of SQL. * Expert using MS Excel, MS Access, MS Word, PowerPoint, MS Outlook and Share Point. * Expert working with formulas, calculations, charts and graphs in MS Excel. * Business, academic or healthcare experience in designing, producing and interpreting quantitative and qualitative analysis outputs. Previous experience should include financial and operational analysis, data manipulation and modeling. * Audit and prepare Budget, Financial Statement, Performa Analysis, Profit and Loss Reports / Statements and reconciliation. * Advanced Math, Probability and Statistics Skills required. * Familiar with healthcare claims/encounter data using CPT / HCPCS/ ICD / DRG / Revenue Codes. * Familiar with eligibility and provider data preferred. * Shared Risk analysis, reporting and reconciliation experience preferred. * Hospital risk pool experience preferred. * Computer literacy with ability to work within several internal and external on line and Web based systems, reports and analytics. * Must have with claims / encounters: Place of Service, Type of Bill, Specialty Categories, etc. * Broad knowledge of the healthcare industry including trends, markets, competitors, financing, regulation, & risk management preferred. * Understanding of privacy and HIPAA standards
Education * Bachelor’s Degree required; Bachelor’s Degree in actuarial science, computer science, finance or quantitative fields preferred. * Master’s Degree preferred. * Successful completion of at least one actuarial exam is highly desirable.