Your Role

The Managed Care Finance team administers the financial terms and conditions of our capitated contracts with IPA/Medical Groups, Hospitals, and Vendors. The Financial Analyst, Experienced will report to the Manager of Managed Care Finance. In this role you will be performing provider contract analysis, financial research, preparing financial forecasts, analyzing data trends, and translating data into useful information. You will interact with a variety of internal units as well as IPA/Medical Groups to monitor financial payments and reporting to ensure compliance with contractual requirements and governmental regulations.

Your Work

In this role, you will:

• Analyze limited raw revenue/expense data and summarize detailed revenue/expense data; compare summarized claim data against fee schedules and contracts
• Assist with production of contract performance reports, modeling of reimbursement rates, evaluation of financial contract modifications and compiling and monitoring key managed care statistics
• Participate in the development of financial models; collect and evaluate data, analyze results
• Perform daily cash desk activities (e.g., account review, funds movement, daily reporting, near-term forecasting)
• Follow and conduct audit processes and review internal controls to ensure financial transactions are accurate, timely and comply with accounting standards, principles and company policy
• Generate reporting and provide analysis of capitation, eligibility, membership, shared risk arrangements, claims, and provider incentive programs
• Develop financial accruals and prepare payments for expenses related to retroactive capitation rate increases, shared risk settlements, provider incentives, provider claims, and other non-standard contract provisions
• Provide contract interpretation consultation (including non-standard contracts) to internal business units and external provider customers
• Assist in the development of new processes and reporting mechanisms to meet company needs and improve customer service
• Address and/or resolve non-standard customer issues and builds strong relationships with customers

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 3 years of prior relevant experience
• Exposure to health care related membership, capitation, claims processing systems, and/or provider contracting is desired
• Knowledge of the functions and responsibilities of other units within a health insurance company and familiarity with the health insurance industry is desired
• Requires the ability to use computers and related software applications including MS Access and/or Excel
• Ability to debug, modify, and enhance existing Access databases and Excel macros and develop new applications in MS Access and/or Excel for automated processes and data manipulation is desired
• Requires the ability to read, analyze and interpret non-standard provider contracts, technical procedures, and governmental regulations

Pay Range: The pay range for this role is $71,280.00 to $99,770.00 for California.

Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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