Medicare Advantage Risk Adjustment Analyst - Health Alliance Plan

This position, formally titled RMRA Analyst III, will assist the Financial Services division, Risk Adjustment Financial Reporting and Analysis department in ensuring responsibilities for reporting of Government Program revenue for Medicare Advantage / MMP product lines. Successful candidates will be seasoned data/finance analysts with experience working in the Medicare Advantage program, Part C & D, and be knowledgeable of CMS payment files, Risk Adjustment data and impact on premiums.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Compile CMS premium payment and revenue reconciliation reports for monthly financial close process; file payment issues with CMS and monitor response; monitor MMR accruals; estimate risk adjustment premium impact for midyear and final reconciliation with CMS; allocation of premium to at-risk provider networks
• Primary user of Risk Adjustment vendor application. Monitor vendor system for assessment of RAPS and EDPS data submission / acceptance status, progress of risk projects, utilization of Vendor supplemental data to assist in risk adjustment project pricing, ongoing assessment of data integrity and completeness issues that may impact risk adjustment project valuation.
• Utilize CMS government program regulatory communications and knowledge and understanding of Risk Adjustment program operations, Risk Adjustment payment methods, HCC-Coding models, to assess impact on government program financial reporting.
• SME Liaison to multiple departments within the organization, including but not limited to Provider Services, Network Management, Actuarial Services, Underwriting, Financial Analysis, Financial Services, Risk Adjustment, IT-Business Intelligence, Data Analytics, Henry Ford Health System Revenue Cycle for expertise in government programs, payment methods, revenue attribution, and risk adjustment.
• Maintenance of the following queries and analysis: Reconciliation reports for CMS MA Part C/D Risk Adjustment program receivables and payables for monthly accounting needs. Monitor accruals for final reconciliation with CMS.
• Maintenance of the following queries and analysis: Reconciliation reports for CMS Part D Reinsurance, Low Income Cost Sharing, Risk Sharing program receivables and payables for monthly accounting needs. Monitor accruals for final reconciliation with CMS.
• Develop and enhance reporting capabilities for financial and operational performance.
• Support annual financial reporting activities including CMS bid filings, RFP on financial Risk Adjustment projects, Employer Group Rate Renewals, financial audits, CMS Attestations, Medical Loss Ratio annual filing requirements, CMS premium, risk adjustment, member and provider revenue budgets.
• Monitor CMS material and calls for required compliance and system or process changes. Work with management on design and implementation of the changes.
• Development and maintenance of departmental policies and procedures for audit purposes and support department in adhering to HAP Compliance department requirements. Complete routine monitoring of departmental procedures and documentation to demonstrate internal (MAR) and external (CMS) audit readiness.
• Coordinate and assigns tasks related to testing IT projects and new system related initiatives and CMS software releases.
• Analyze department reports to identify data integrity issues, system and programming problems, and work with management to develop and implement improvement solutions.
• Assist department in performing routine assignments, ad-hoc projects and meeting established deadlines. Engage assistance of departmental support analysts in completion of required responsibilities where appropriate.
• Basic Accounting principles for Journal Entry preparation and Account reconciliation.
• Perform other related duties as assigned.

EDUCATION/EXPERIENCE REQUIRED:

• Bachelor’s degree in Accounting, Finance, Business Administration or a related field required (must include financial or accounting related course work) Master’s degree preferred (Finance, Business Administration, etc.)
• Completion of Advanced Access, Excel, GQL, Cognos, or SQL training
• Two (2) years of Accounting/Finance business related experience
• Two (2) years managing projects and initiatives designed to improve business operations
• Three (3) to Five (5) years of experience developing, analyzing, interpreting & trending data preferred.
• Experience with Medicare Advantage, Medicare Part D, Medicaid or Qualified Health Plans.
• Affordable Care Act (ACA) experience or knowledge preferred.
• Strong understanding of Risk Score, CMS Risk Adjustment HCC and RxHCC models, RAPS/EDPS data, and impact on premiums in government programs
• Proficient knowledge of MS Office products Advanced Access, Advanced Excel, Power Point, and Word
• Experience in health care finance, claims processing, and Medicare and Medicare/Medicaid program payment methods preferred
• Accounting and finance principles as they relate to revenue payments, claims, and membership data, financial projections, variance analysis
• Prior experience with Change Healthcare suite of Medicare Advantage, Medicaid Suite of applications such as Risk View, Encounter Complete, strongly preferred
• Proficiency in Power BI and or Tableau preferred

Under the leadership of President and CEO Wright L. Lassiter, III, Henry Ford Health System is a

$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites

including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and

other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system

now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one

of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the

health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s

major academic medical centers, receiving between $90-$100 million in annual research funding and

remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical

education and training, the health system has trained nearly 40% of physicians currently practicing

in the state and also provides education and training for other health professionals including nurses,

pharmacists, radiology and respiratory technicians. visit HenryFord.com.

Whether it's offering a new medical option, helping you make healthier lifestyle choices or

making the employee enrollment selection experience easier, it's all about choice. Henry

Ford Health System has a new approach for its employee benefits program - My Choice

Rewards. My Choice Rewards is a program as diverse as the people it serves. There are

dozens of options for all of our employees including compensation, benefits, work/life balance

and learning - options that enhance your career and add value to your personal life. As an

employee you are provided access to Retirement Programs, an Employee Assistance Program

(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness, and a whole host of other benefits and services. Employee's classified as contingent status are not eligible for benefits.

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is

committed to the hiring, advancement and fair treatment of all individuals without regard to

race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,

weight, marital status, family status, gender identity, sexual orientation, and genetic information,

or any other protected status in accordance with applicable federal and state laws.