Capitation Revenue Analyst

Your career starts now. We''re looking for the next generation of health care leaders.At AmeriHealth Caritas, we''re passionate about helping people get care, stay well and build healthy communities. As one of the nation''s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we''d like to hear from you.Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at Responsibilities:This role is responsible for accurate and timely preparation and analysis of financial reconciliations of {HIPAA 5010} monthly 820 premium payment files and {HIPAA 5010} 834 membership files. This role requires skills to manage, maintain and manipulate data in both Microsoft Access databases and Microsoft SQL. The Analyst is responsible for assigned lines of business. Additionally, the Analyst may be accountable for maintaining reinsurance processes as appropriate.Analyze and interpret financial data from sources such as 834 (enrollment/membership) and 820 (payment/financial) files, Lock-in files, Jiva, Data Warehouse, and the Facets System to create a view into discrepancies determine best approach for resolution and make recommendation.Maintains and creates databases, queries, joins, tables and forms; designs and creates SQL stored procedures, technical specifications and user-defined functions, writing functional and technical specification documents.Prepare and maintain discrepancy reports, state reporting and or other plan specific financial reporting to identify, reconcile, and control variances for maximum profitability.Generates and updates reports for monthly reconciliation, financial audits and all other required reporting; Analyzes completed reports to ensure there are no material differences that should be escalated to management for review.Become familiar with and understand existing and new 834 (enrollment/membership) and 820 (payment/financial) companion guides, system notices and or member documentation, adherence to requirements; advise management on needed actions to comply with state requirements.Responsible for meeting all monthly/ quarterly deadlines; provides full support to other areas such as Accounting, EDI, Enrollment, Encounters, Statutory and the Actuarial departments.Participates in the completion of all designated annual goals for the Financial Services department.Support stakeholders explorations and information request within departmental timeframes.Prepared for onsite audits of all tasks requiring process explanation and accountability.Education/ Experience:Bachelor''s Degree preferred.1 to 3 years Revenue Code Mapping, Data Analysis, Data warehousing, translated 5010 EDI files, financial reporting, electronic remittance advice (codes) and related financial analysis experience.Solid analytical skills and problem solving skills with the ability to articulate and communicate recommendations for enhancement.Strong working knowledge of business computer programs, applications and systems, database structures and data files required. Understanding of clinical coding or claims processing preferred.Two years'' experience in healthcare finance and/or financial reporting, preferred.Strong communication (both written and verbal), analytical and problem solving skills.Strong organizational skills with ability to coordinate several projects simultaneously.Ability to work on multiple tasks with competing priorities; demonstrates strong subject matter expertise in the states and business processes that they support.Ability to work accurately and independently as well as comfortable interacting collaboratively with all levels of business; open mind to consider alternative ideas and next steps for remediation.Proficient inMicrosoft SQL Server, Oracle, My SQL, SQL Server Reporting Services.Proficiency in Excel, Access, Monarch preferred.Fluent in file data mapping both in Access and SQL.NOTE: Due to COVID-19, Associates are presently working remotely. When Associates are transitioned back to the office, the functions of this position will be performed onsite at our offices located at 3805 West Chester Pike, Newtown Square, 19073. BackShareApply Now

Created: 2021-11-29