Sr. Revenue Analyst

Job Description:

POSITION SUMMARY

Support the development and implementation of revenue optimization through the analysis of medical and pharmacy claims, prospective and retrospective review data and related functional activities to support unit and corporate goals.

GENERAL RESPONSIBILITIES

* Develop databases for the collection, tracking and reporting of data.
* Develop and modify revenue models to project
future healthcare revenue by market using knowledge of Medicare's reimbursement system, including a thorough knowledge and understanding of risk adjustment, HCC coding, etc.
* Develop and review trend experience by market to understand reasons for changes in medical revenue and changes in medical revenue relationships/clinical interventions.
* Perform analyses and projections to address business issues and support the ongoing evaluation process.
* Develop analysis models, tools and databases to support financial and clinical analyses.
* Maintain and perform analysis for corporate decision support.
* Assist in the development and evaluation for ad-hoc studies/initiatives.
* Other duties as assigned.

REQUIRED EDUCATION AND EXPERIENCE
* Minimum of five years experience as a financial analyst, actuary, or economist in managed care, preferably in a Medicare Advantage Plan healthplan setting.
* Masters degree in statistics, business, finance, economics, computer science or other appropriate discipline required.

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES
* Exceptional problem solving and analytical skills.
* Strong abilities with the tools utilized in data analysis and related software implementation, such as SQL Server Enterprise Manager.
* Previous Medicare/HMO/Managed Care Industry experience.
* Thorough knowledge and understanding of Risk Adjustment, HCC coding, etc.
* Advanced skills in Microsoft Excel, Microsoft Access, and SQL or other relational database applications.
* Knowledge of Business Objects/Crystal Reports preferred.
* Proficient with Windows-based environment including Microsoft Office products.

We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.