Job Description

Summary

The Analyst will manage and coordinate the preparation and payment of a state sponsored incentive program to providers from multiple health plans to multiple IPA’s.  This will include reconciliation and identification of PCPs and qualified vendors, and verifying payment amounts through the entire process by communicating with team members. Creating attestation documents for Health plan reimbursement fees. The analyst will be the point person on any follow up from providers to resolve any and all issues regarding these payments. The analyst is a key liaison and "front-line" financial resource between provider and internal MPM teams and serves to create a forward-focused guiding vision and environment of "no surprises".

The analyst will help manage the preparation and payment of Provider Capitation & Specialty Capitation issued from IPA’s to the Primary Care Physicians/Specialists.  This process will include reconciliation of the current payment with previous, identifying and researching any areas of concern that may arise during the process, working directly with key members of IT and Provider Network Operations to get the process completed.  This includes the accurate quantification and measurement of membership eligibility to health plan membership.  In addition, other key responsibilities include analyzing and reporting of monthly membership data to determine discrepancies between revenue and eligibility.

Duties and Responsibilities:

• Maintain source documents of state sponsored incentive programs and coordinate the Payment process of these incentives to providers. 
• Identify recipients of incentives and initiate payment process with team members to ensure accuracy and timeliness of payments.
• Reconcile payments after team members preparation of payments to ensure accuracy.
• Communicate follow up issues from providers with team members to resolve provider concerns.

• Prepare attestation forms for each payment received to issue to health plans in order receive MedPOINT’s administration fees.
• Working with Information Technology Department to identify and implement system corrections and enhancements
• Processing, quality reviewing and issuing monthly capitation payments.
• Ensuring the accuracy and timeliness of monthly Medicare HMO capitation and specialty capitation payments.
• Provides up to date review of capitation rate table configurations errors or concerns.
• Maintaining capitation records, files and monitoring reports to ensure accuracy of payment and compliance with contractual and regulatory requirements.
• Prepare capitation or other ad-hoc financial analysis as requested by the Controller, CFO, and/or the client.

Minimum Job Requirements:

Bachelor’s degree or an equivalent combination of education, training and experience is required.

3+ years of Physician Organization or Health Plan, Hospital Finance and/or Health Plan experience.

Knowledge, Skills and Abilities Required:

• Demonstrates intermediate to advanced understanding and experience using Excel (VBA’s, macros. Pivot tables, vlookup, hlookup), MS Access and other Microsoft Office Systems required.
• Ability to communicate clearly and effectively, work accurately, meet deadlines and provide effective reporting is required.
• Excellent interpersonal skills required to develop and maintain effective working relationships across all levels within the organization.
• Ability to work both independently and as part of a team.
• Willingness to ensure the job is performed within specified parameters and deadlines is essential
• Crystal/SQL knowledge and experience is a plus
• Knowledge of Ez-cap6 is a plus
• Must work effectively in a team environment and be able to be a supportive contributor or leader in team matters.  Must conduct him or herself professionally and be capable of developing and maintaining positive, service-oriented relationships with all levels of healthcare professionals, both internal and external.

• Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Performs additional duties as assigned.

Salary:

• $28-$35 hourly

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