Senior Financial Analyst - Medicare Advantage Finance

Job Description

Job Description

Description:

Verda Healthcare, Inc. is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to the idea that healthcare should be easily and equitably accessed by all, currently available in Texas and Arizona. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a Senior Financial Analyst – Medicare Advantage Finance to join our growing company with many internal opportunities

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare health plan is looking for people like you who value excellence, integrity, care and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.

Align your career goals with Verda Healthcare, Inc. and we will support you all the way.

Position Overview
The Senior Financial Analyst manages critical financial operations for our Medicare Advantage (MA) lines of business on-site in Huntington Beach. This role owns regulatory financial reporting, Centers for Medicare & Medicaid Services (CMS) revenue reconciliation, and assists in monthly financial close processes. The ideal candidate ensures compliance with federal and state mandates while optimizing revenue accuracy through detailed data analysis.

This position reports to VP of Finance, Pranab Rout.

Responsibilities:

Regulatory Reporting & Compliance

· Prepare monthly, quarterly, and annual CMS financial filings in a timely and accurate manner.

· Complete annual Medicare Part C & D Bid pricing support documents.

· Ensure full compliance with National Association of Insurance Commissioners (NAIC) reporting standards.

· Coordinate with external auditors for all quarterly & annual regulatory financial reviews.

· Submit accurate Medical Loss Ratio (MLR) reports to CMS.

Revenue Reconciliation & Analysis

· Reconcile monthly CMS Membership Summary Reports (MMSR) against internal data.

· Track and validate Plan Payment Reports (PPR) for payment discrepancies.

· Analyze Risk Adjustment Processing System (RAPS) and Encounter Data System (EDS) impacts.

· Monitor Mid-Year and Final Risk Score settlements from CMS.

· Investigate and resolve premium variances at the member level.

Financial Planning & Close

· Assist in month-end close activities for the Medicare Advantage business unit.

· Prepare journal entries for capitation revenues and premium receivables.

· Analyze actual-to-budget variances for premium revenues and medical expenses.

· Develop monthly financial dashboards for senior leadership review.

· Forecast premium revenues based on enrollment trends and risk scores.

· Complete ad-hoc projects or tasks, as assigned.

Minimum Qualifications

· Bachelor’s degree in Finance, Accounting, or a related field.

· Minimum 3–5 years of financial analysis experience in healthcare.

· At least 2 years of direct experience with Medicare Advantage plans.

· Strong understanding of GAAP and/or statutory accounting principles.

· Proficiency in MS Office is required.

· Ability to work fully on site in the Huntington Beach office.

Technical Skills

· Advanced proficiency in Microsoft Excel (VLOOKUPs, Pivot Tables, Power Query).

· Strong SQL querying skills to extract complex healthcare data.

· Experience using financial ERP systems (e.g., QuickBooks Online, Oracle, Workday, SAP).

Professional Competencies

· Deep understanding of CMS payment methodologies and risk adjustment models.

· Familiarity with healthcare coding frameworks (ICD-10, CPT, HCPCS).

· Excellent analytical, problem-solving, and data validation skills.

· Excellent written and verbal communication skills, with the ability to work independently as well as with different departments within the organization.

· Driven, detail-oriented and strong analytical and organization skills with the ability to identify issues and provide recommendations for process improvements.

· Ability to multi-task and adapt with changes in tasks and timelines.

· Experience working in a fast paced and heavy deadline-driven environment, with willingness to work extra hours, as necessary.

Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type: Full-time employment
Location: Huntington Beach, CA (100% onsite)

Compensation Range:

$95,000 – $110,000 annually

Actual compensation offered will be determined based on experience, qualifications, skills, internal equity (if available), and geographic location. This position may also be eligible for performance-based incentive compensation and benefits.

Benefits:

• 401(k)
• Paid time off (vacation, holiday, sick leave)
• Health insurance
• Dental Insurance
• Vision insurance
• Life insurance

Schedule:

• Full-time onsite (100% in-office)
• Hours of operations: 9am – 6pm
• Standard business hours Monday to Friday/weekends as needed
• Occasional travel may be required for meetings and training sessions.

Ability to commute/relocate:

• Reliably commute or planning to relocate before starting work (Required)

PHYSICAL DEMANDS

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

* Other duties may be assigned in support of departmental goals.