Lead Financial Analyst, Shared Risk

Job Category:  Accounting/Finance
Department:  Medical Payment System & Services
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  3862

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Lead Capitation/ShareRisk Analyst, is responsible for leading the Senior Financial Analyst team to ensure the accuracy of the monthly financial activity for all lines of business including Medi-Cal.   This position will provide oversight of the capitation payments for Shared Risk, Dual Risk and Full Risk service agreements.   The position will provide guidance to the Senior Financial Analysts on the processing and  accuracy of provider incentives, claims analysis, journal entry preparation, account analysis, month-end reconciliations and preparation of financial reporting tools for contracted Ancillaries, Participating Provider Groups (PPGs) and hospitals for all capitated lines of business.  This position will interface with cross functional teams and serve as unit liaison with multiple departments,  such as,  Member Services, Configuration, IT, Provider Network Operations and externally with the Participating Provider Groups.  This position will train and mentor new  and existing staff on all lines of business on process improvement and organizational changes.  This position will communicate to manager abnormalities, root cause and resolutions.

Duties

Ensures the Senior Financial Analysts prepare accurate and timely  analysis of multiple types of provider Capitation and incentive payments for Shared Risk, Dual Risk and Full Risk service agreements. Ensures that adjustments are made within specified time limits outlined in regulatory SB260 guidelines. This position will communicate abnormalities, root cause and resolution.

Responsible for quality reviewing/ auditing reconciled Shared Risk, Dual Risk, and Full Risk service agreement analysis.  Identifies capitation and revenue trends and resolves issues/errors. Maintains capitation records, files and monitoring reports to ensure accuracy of payment and compliance with the contractual and regulatory requirements.  Monitors PPG Contracts, Service Agreements and rate review. Ensures receivables and payables are recorded correctly in general ledger according to contractual agreements. Communicates contract issues to the appropriate Director or Manager and ensures timely resolutions.

Reviews and approves Senior Financial analyst Journal Entries and related General Ledger account analysis and reconciliation of Shared Risk, Dual Risk and Full Risk service agreements, incentives and capitation databases. Collaborates with IT to identify and implement system corrections and enhancements. Maintains data integrity in systems by communication to multiple departments the abnormalities. Confirming accuracy of all system set-ups and conducting regularly scheduled system reviews to ensure data accuracy.

Generate monthly financial activity reporting tools for Capitation and medical costs for all line of business. Compiles, analyzes and reports on operational results. Collaborates with other analysts on finance projects in developing forecast and budget models, performing trend and cost-benefit analyses.

This position will identify and develop the process improvements affecting the Capitation Unit.  They will communicate to the directory or manager and the team the efficiencies proposed,  They will collaborate with other stakeholder and specialists the best practice methods. This position will prepare the  policy and procedures along with the desk procedure manual.. The manual will be used for training and mentoring new staff on Capitation process.

Perform other duties as assigned.

Education

High School Diploma/GED

Associate's Degree or Bachelor's Degree in Accounting and/or Finance

Experience


Required:
With Bachelor's Degree: 5 years of experience in capitation, finance and/or accounting with 3 years in an accounting lead role

Preferred:
With Master's Degree: 3 years of experience in capitation, finance and/or accounting with 3 years in an accounting lead roles.

Equivalent Experience:
With High School Diploma/GED: 10 years of experience in capitation, finance and/or accounting with 3 years in an accounting lead role.

With Associate's Degree: 7 years of experience in capitation, finance and/or accounting with 3 years in an accounting lead role.

Professional Certifications


Preferred:
CPA

Skills

Required:
Knowledgeable in payment processing, remittance advice, EFT, 834.

Knowledgeable in accounting/capitation, retroactivity processing and finance reconciliation

Comprehensive knowledge of computers and related financial software.

Proficiency in Microsoft Excel and Microsoft Access.

Excellent verbal/written communication skills.

Familiarity with automated accounting and financial systems.

Ability to read, analyze and interpret business periodicals, professional journals, technical procedures and governmental regulatory requirements.

Ability to write reports, business correspondence and procedure manuals.

Demonstrate ability to work with complex databases

 

L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)


Nearest Major Market: Los Angeles

Job Segment: Accounts Payable, Risk Management, Financial, Medical, Financial Analyst, Finance, Healthcare