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Shared Risk Financial Analyst III (ALD)

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

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  7593

 

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.

As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.

Job Summary

The Financial Analyst III is responsible for preparation and analysis of multiple providers Shared Risk budget amount calculation, claims analysis, journal entry preparation, account analysis, month-end reconciliations and preparation of financial reporting tools for contracted Participating Provider Groups(PPG) for assigned lines of business. Interfaces and serves as liaison with multiple departments and communicates with contracted PPGs as necessary to answer/Resolve Provider Concerns.

Duties

Responsible for preparation and analysis of multiple providers shared risk agreements, calculation of shared risk budget amount, and annual shared risk settlement payments. Prepare accurate and timely analysis and reports for the contracted PPGs. Adjustments made within specified time limits outlined in regulatory SB260 guidelines.

 

Responsible for the auditing functions needed to produce a reconciled, Shared Risk analysis.  Involves monitoring claims activity, DFOR review, reconciling Shared Risk contributions and providing monthly statements and annual settlement statements.  Ensure receivables are netted according to contractual arrangements.  

 

Prepare Journal Entries and perform related General Ledger Account analysis and reconciliation of both Shared Risk, Incentives and capitation databases.  

 

Generate monthly financial reporting tools for Shared Risk expense and medical costs for assigned line of business.

 

Prepare and participate in the completion of all assigned and ad-hoc projects.

 

Responsible for proper data management.

 

Perform other duties as assigned. 

Education Required

Bachelor's Degree in Finance or Related Field
In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Master's Degree in Finance or Related Field

Experience


Required:
At least 3-5 years of experience in a healthcare setting (HMO and IPA), extensive knowledge of capitation and/or shared risk and demonstrated ability to work with complex databases.

 

Experience in reconciling risk pools, claims experience and understanding DOFR.

 

Preferred:  
At least 2 years of experience in a healthcare setting (HMO and IPA), extensive knowledge of capitation and/or shared risk and demonstrated ability to work with complex databases.

Skills


Required:
Strong accounting, analytical, and problem-solving skills.

 

Excellent communication skills, oral and written.

 

Excellent data management/ database skills.

 

Must have advanced PC Skills (Excel, Word, Access) ASP, and SQL or Monarch.

 

Preferred:
Medi-Cal, Medicare knowledge.

 

QNXT application knowledge.

Licenses/Certifications Required

Licenses/Certifications Preferred

Certified Public Accountant (CPA)

Required Training

Additional Information

 

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)

 

At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.


Nearest Major Market: Los Angeles

Job Segment: Accounting, CPA, Financial Analyst, Claims, Financial, Finance, Insurance

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