Job Description

Your Role

The Blue Shield of California Promise Health Plan (BSCPHP) Finance team is responsible for implementing program requirements from Department of healthcare Services (DHCS) and other regulators, and monitoring Medi-Cal financial performance including budget variances, growth and cost trends, forecasts, scenario modeling, and financial reporting. Medi-Cal programs managed within BSCPHP Finance team include but are not limited to Proposition 56 Supplemental Payment program, Hospital and other Directed Payment programs, CalAIM Incentive Payment Programs, Skilled Nursing Facility Incentive Program. Financial Analyst, Consultant will report to the Finance Analytics Manager.

In this role you will be responsible for interpreting guidance from external and internal stakeholders, researching best practices, extracting, manipulating, and analyzing data, developing and implementing sustainable, repeatable, and quantifiable operational processes. It will be expected that you will provide various routine and on-demand reports related to Medi-Cal line of Business for internal and external stakeholders. You will work closely and collaborate with other IT, Claims Processing, Encounters, Actuarial, Accounting, and Operations Finance departments as well as external parties such as regulators and provider entities.

Your Work

In this role, you will:

• Take ownership of routine programmatic reporting requirements and reconciliation with regulator and provider entities participating in Medi-Cal special programs
• Assist in identifying systems and operational problems and recommend solutions and changes to streamline processes and reports
• Develop process maps of manual and automated business processes for Medi-Cal Directed Payment programs, capturing data and system workflows, describing the roles, activities, inputs and outputs
• Identify and implement moderate improvements of operational end to end processes within Finance, to enhance performance across functional business areas within the enterprise
• Follow and conduct audit processes and review internal controls to ensure financial transactions are related to Medi-Cal Special Programs are accurate, timely and comply with accounting standards, principles and company policy
• Collect and evaluate data, develop and maintain financial models, analyze results and conduct scenario analyses 
• Present effectively to internal and external customers 
• Communicate effectively with financial, technical, and business partners 

Your Knowledge and Experience  

• Requires a bachelor's degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• At least 3 years of relevant Managed Healthcare experience required
• Meaningful experience working with claims and encounter data required
• Demonstrated advanced proficiency and experience working with database development tools (SQL, Netezza, Visual Studio, etc.)
• Superior math, analytical and problem-solving skills, and use of analytical tools with demonstrated advanced proficiency with Microsoft Excel (Pivot Tables, VLookups, Macros), Word, and PowerPoint

Job Tags

Similar Jobs