Financial Analyst
Core
Ensures accurate system configuration, capitation payment processing, accruals, shared risk pool calculation, and claims expense recording for Medicare Advantage and integrated care models.
Role type
Senior Financial Analyst (Healthcare Operations)
Builds
Capitation and shared risk payment modules for Medicare Advantage and integrated care programs
Domain
Healthcare / Medicare Advantage / Managed Care
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure
Required skills
Capitation payment processing, shared risk pool calculation, claims expense recording, CMS bid preparation, system configuration, data integrity management, contractual agreement interpretation, financial forecasting, audit initiation, process improvement
Preferred skills
AI curiosity, advanced analytical skills, mentoring
Technologies
Microsoft Office Suite, capitation modules, shared risk modules
Responsibilities
Lead intradepartmental meetings for audit, accruals, and CMS bids; oversee shared risk pool settlements; liaise with Network Management, Claims, and Actuary for contract application accuracy; maintain and test capitation and shared risk system configurations; ensure timely provider capitation payments; evaluate contractual agreements for payment methodologies; compile complex capitation information and forecasts; initiate membership and payment audits.
Seniority
Senior, hands-on IC with mentoring responsibilities
