Financial Analyst II-Capitation (Full-Time Remote, North Carolina Based)

The Financial Analyst II for Capitation is responsible for accurate monthly capitated payments reconciliations, reporting and analysis. Incumbents may analyze workflows and processes and institute new workflows and processes or make improvements to existing to achieve greater efficiency.

This is a full-time remote position. The successful candidate must reside in North Carolina. 

Responsibilities & Duties

Analyze and Reconcile Capitation payments

• Ensure TBI and Innovations Accounts Receivable (A/R) accuracy by tracking updated information contained in subsequent monthly report data from the State and Alliance Slot Tracking Reports
• Update TBI and Innovations reconciliations as necessary with rate changes or discrepancies
• Attend weekly meetings with the State to resolve Capitation Reconciliation discrepancies should tickets be submitted
• Track and organize State changes in the PMPM rates overtime and make changes to other dependencies
• Complete reconciliations for capitated payment arrangements with subcontractors based on Alliance membership, contract agreements and submitted invoices

Complete Reports and monitor trends

• Complete A/R, Liability, Accrual and Capitated Payment reports used by accounting at month end close including Medicaid AR, Risk Reserve and any other adhoc requests necessary with rate changes
• Complete the Monthly Membership Model using capitated payment data utilizing SQL
• Submit State Capitation Reconciliation monthly reports
• Complete hardship payment requests and payment plan details
• Complete monthly Medicaid and TCM trend analysis report for review by management 
• Monitor trends for any unusual changes or increased/decreased growth
• Identify and drivers of variances and present findings
• Develop new KPI’s or insights into trend behaviors

Develop and Implement Processes, workflows, and reporting 

• Aid in development of processes for new vendor/subcontractors and complete related new desk procedures
• Create desk procedures for other processes and workflows
• Recognize areas that can be improved upon and establish new reporting that would be insightful and impactful for decision makers
• Innovate workflows to create a more sustainable and accurate process that can be repeated and documented 

Collaborate with departments and sub-contractors to resolve member issues

• Responsible for assisting other units in resolving member errors or issues blocking capitated payments and access to services
• Liaise with subcontractors on capitated payment arrangements

Minimum Requirements

Education & Experience

 Associates Degree in Business Administration, Finance, Public Policy, Hospital Administration, or related field and at least five (5) …