Financial Analyst III - Covered California

at  Inland Empire Health Plan

WHAT YOU CAN EXPECT!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!
Reporting to the Supervisor of Finance Analytics - Commercial Finance, the Financial Analyst III - Commercial Finance will lead and/or complete a variety of complex high-level duties related to financial reconciliation of premium invoicing and payments from various sources, monitoring of BPO vendor, collaborating with cross-departmental teams to resolve payments issues, and ad-hoc analysis as it relates to the commercial products. This role will work with large data sets and develop complex SQL queries. This position will independently identify issues, problem-solve, and communicate effectively (both written and verbal).

EDUCATION & EXPERIENCE

• Minimum five (5) years of premium billing, premium and membership reconciliation, and/or premium reporting experience that includes some experience in leading financial analyses pertaining to premium payments. Experience working with other finance teams to support monthly financial reporting. Significant experience working with large data sets and developing complex SQL queries. Managed care experience related to commercial products required
• Bachelor’s degree in Finance, Business Administration, Economics, Health Care Administration, Accounting, or other related field from an accredited institution required.

KEY QUALIFICATIONS

• Expert knowledge in premium billing practices in the healthcare industry. Strong knowledge of generally accepted accounting principles (GAAP) and the practical application of general accounting theory.
• Must have SQL Server query development and writing skills. Expert skills in utilizing Excel and Word. Strong communication abilities (both written and verbal) and problem-solving skills. Lead capacity skills. Advanced critical thinking, analytical, problem solving, and prioritizing abilities.
• Work independently or with little direction and strong initiative to meet established deadlines. High level of attention to detail is required. Be able to communicate effectively at all organizational levels both orally and written.
  Start your journey towards a thriving future with IEHP and apply TODAY!

1. Monitor and respond to 2nd level inquiries related to payment reconciliation and/or any other issues.
2. Analyze complex over- or under-premium payments and submit findings for leadership review.
3. Perform 2nd level research into member premium issues and/discrepancies and provides recommendations on solutions.
4. Program complex SQL queries to perform reconciliation of various revenue streams (i.e.: Member payments, APTC payments, state credit/subsidies) to ensure Member accounts are accurate.
5. Resolve complex payment disputes received from the merchant services vendor and lockbox decisioning items received from bank lockbox to ensure funds are accurately applied to member accounts in a timely manner.
6. Review work output/deliverables of lower-level analyst on the team.
7. Work with 3rd party print vendor to create/update all premium related notifications, as required by regulatory guidelines.
8. Provide in-depth moderate to complex business requirements to BPO vendor for programming modifications related to premium invoicing and/or other business needs.
9. Lead discussions on root-cause analysis regarding systems/software and process issues regarding premium and invoicing workflows.
10. Perform detailed analysis of refund requests and/or overpayments and process member refunds.
11. Perform verification of internal and external broker commission payments to ensure accuracy of payments.
12. Prepare month end reports and/or journal entries for monthly financial reporting and management reporting requirements.
13. Perform accurate interpretation of complex regulatory requirements as it pertains to premium billing activities, member notices as it relates to member premiums, and revenue reconciliation requirements.
14. Act as a trusted resource for the organization and consistently demonstrates IEHP organizational values while building and maintaining strong internal relationships.
15. Demonstrate a commitment to incorporate LEAN principles into daily work.
16. Design, create and maintain processes to ensure compliance with commercial regulations.
17. Partner in ensuring quality and accuracy of the work deliverables are maintained.
18. Any other duties as required ensuring Health Plan operations are successful.
    Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.