Senior Financial Analyst - Minnetonka, MN - Full-time / Part-time

The Sr. Financial Analyst will develop expert knowledge of the CMS-HCC and RxHCC risk adjustment model, its concepts and methodology in order to reconcile CMS risk score reports, project future revenue related to risk adjustment and evaluate financial impacts of risk adjustment initiatives. In addition to ensuring the accuracy, quality and integrity of the data, this person will perform detailed and complex analyses in order to evaluate risk score trends. This position will be responsible for managing projects related to systems/technical solutions, requirements gathering and documentation, and troubleshooting and resolution. The ideal candidate for this position will be proficient in SAS or SQL and have a strong analytic experience; additionally, they need to be results oriented and willing to do whatever it takes to manage a project to completion.
 
Primary Responsibilities:


Validate RxHCC risk adjustment extract logic, which includes oversight of logic programmed within internal systems based on CMS rules and guidelines

Monitor CMS changes to the RxHCC risk adjustment process and calculate any corresponding impacts

Provides short range trouble shooting for day to day issues and ongoing maintenance with the RxHCC risk adjustment applications and reporting

Makes recommendations as needed to ensure reliability of the process and finds innovative solutions if problems should occur

Provides encounter data reconciliation between CMS and health plan claims detail to ensure accurate RxHCC risk adjustment payments

Ensures that the CMS return files received either directly from CMS or from the health plan or their intermediary are reconciled to the submitted files

Develops policies and procedures for system, application and related operational processes in order to ensure optimization and compliance with CMS RxHCC risk adjustment guidelines

Maintains RxHCC risk adjustment data base for complex analytics

Analyze, review, forecast, and trend complex data

Review the analysis and interpretation of others work

Present analysis and interpretation for operational and business review and planning

Develop ad-hoc and standard operational reports

Support short and long term operational/strategic business activities through analysis

Develop and implement effective/strategic business solutions through research and analysis of data and business processes

Document/Communicate root causes affecting performance as identified through analysis

Determine and track financial implications of initiatives

Document/communicate key milestones for effective strategy execution
 
 

Required Qualifications:


Bachelor’s degree

3+ years of healthcare data analysis experience in a healthcare plan or environment, preferably in Medicare

At least an intermediate level of experience in SAS and/or SQL

Intermediate level or above in MS Excel

Ability to identify underlying causes and potential mitigation strategies for medical cost trends, based on broad knowledge of healthcare issues

Proven ability to use large data sets to produce high quality analysis and metrics

Proven ability to perform statistical analyses to independently identify root causes of medical cost trends
Preferred Qualifications:


Risk adjustment experience

Knowledge of ETL (Extract, Transform, Load) processes
Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You’ll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It’s time to do your life’s best work.(sm)
 
 
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
 
 
Job Keywords: Sr. Financial Analyst, data analysis, Medicare, SAS, SQL, ETL, Minnetonka, MN, Minnesota
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