Health Care Service Corporation Financial Analyst II (Financial Modeling) in Helena, Montana
This position is responsible for performing moderate to complex financial analyses and special projects; ie preparing all necessary financial analyses.
Job Purpose: This position is responsible for analyzing, resolving, and responding to concerns of a financial nature that originate from Provider Settlements/Incentives that utilizes information from Actuarial Reserving, Forecasting and Reporting departments; identifying and resolving claims expense, membership and contract anomalies with IPAs, drafting specifications for system/reporting changes for Settlement/Incentives calculations.
* Maintain the calculations of medical group/Independent Provider Association (IPA) Provider Fund earnings, IPA information, provider claims and Insurer LOB membership.
* Prepare Provider Financial Settlement calculations within the HMO/PPO, and any IPA challenges to while ensuring the accuracy of fund calculations to be reviewed by Unit Manager and Manager.
* Coordinate with the Data Team to resolve provider inquiries/issues with Utilization Management fund calculations, and FFV reconciliations.
*Value Based Care related quality calculations for Pay for Performance (PFP) and Fee for Value (FFV)
* Analyze and make recommendations of a financial nature to the Manager concerning annual proposed changes to the Medical Service Agreement (MSA), the annual contract between medical groups/IPAs and HCSC.
* Develop and coordinate corrective action plans and monitor outcomes for the Provider Settlement calculations.
* Timely implementation of capitation rate changes and the creation of new capitation schedules for new benefit structures for all business.
* Quality control monitoring of data/reports created by the Data Team for usage in payments to the IPAs.
* Participate in workgroups and/or committees created by ENS to deal with policies and procedures as they apply to various LOBs members and/or medical groups/IPAs.
Required Job Qualifications:
* Bachelor Degree in Business, Finance, Accounting, Math, Statistics, Economics, Computer Programming.
* 4 years experience Financial Modeling, Calculations.
* Verbal and written communication skills.
* Analytical skills.
* PC proficiency to include Microsoft Word, Access, Excel, Visual Basic, or other programming experience.
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
BCBSTX complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.