Kelsey-Seybold

Healthcare Finance Data Analyst Manager

US-TX-Pearland
2 weeks ago
Job ID
2017-17960
Category
Non-Clinical Management

Overview

Healthcare Finance Data Analyst Manager

Location: Pearland Administrative Office
Job Type: Full-Time
Department: KS Plan Advantage-Healthcare Finance

 

COMPANY PROFILE

Kelsey-Seybold Clinic. Your Doctors for Life.

Since 1949, Kelsey-Seybold Clinic has served its patients with one goal in mind – combine the expertise of physicians in a variety of medical specialties, with the close personal care of a family doctor. Kelsey-Seybold is Houston’s largest community-based physician group, caring for more than 400,000 patients. With 21 clinic locations, we are growing to meet the health care needs of our diverse patient population. Our mission is to provide our team members with exceptional opportunities for professional and personal growth.​​

 

JOB SUMMARY

Reviews and analyzes all financial aspects of KS Plan Administrator's (KelseyCare Advantage) contracts with the Center for Medicare and Medicaid (CMS) and contracted providers utilizing underwriting skills, general health plan and managed care principals along with knowledge of government insurance programs and Medicare Advantage. Analyze risk, identify cost containment and revenue enhancement opportunities.  Provides underwriting analysis, tracking and management of renewal and quote activity for the KSPA Direct Network sales office.

 

 

EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS

(A = basics; B = preferred)

 

Education

A.

  • BA/BS Degree

B.

  •   MBA or MHA preferred

Experience

A.

  •   7-9 years of experience in   Health Care finance including direct responsibility for medical data   analysis  and the development of claim   and premiums/cost projections for group medical plans.

 

 

 

B.

  •   Prior systems experience e(i.e. enrollment/eligibility,   capitation, claims payment, etc.) with a MCO.
  •   3-5years of Medicare Advantage payment experience.

 

  •   3-5 years of Management Experience

 

Licenses

A.

  •   Demonstrated knowledge of  physician coding and billing practice to   include ICD-9 and CPT
  •   Demonstrated knowledge of IBNR models
  •   Demonstrated knowledge of actuarial   cost analysis and pmpm modeling
  •   Demonstrated knowledge of medical   insurance products and the ability to analyze and assess risks are required.
  •   Demonstrated knowledge of CMS HCC   model and Risk Adjustment calculations.

 

B.

  •   Experience with EPIC systems   including hyperspace and Clarity tables
  •   Experience with third party Medicare   Solution tools for RAPS, EDPS, and payment reconciliation.

 

Special   Skills

A.

  • 2-3   Yrs demonstrated SQL programming experience

 

B.

 

 

 

 

 

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WORKING ENVIRONMENT

Office

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