Sr Managed Care Financial Analyst

JOB SUMMARY

The Senior Managed Care Financial Analyst leads the financial oversight and performance reporting of delegated risk and value-based care arrangements for LaSalle Medical Associates and LaSalle Health Plan. Reporting to the Director of Healthcare Analytics, the Senior Managed Care Financial Analyst is accountable for the accuracy and timeliness of the full financial lifecycle of delegated risk arrangements, including capitation, medical cost, shared savings/losses, quality bonuses, risk pools, risk corridors, and stop-loss. The Senior Managed Care Financial Analyst is responsible for ensuring alignment with delegated agreements, capitation arrangements, and regulatory, contractual, and organizational requirements. This position collaborates closely with other departments and senior leadership to optimize financial outcomes across capitation, shared savings, and fee-for-service models. The Senior Managed Care Financial Analyst is essential to the successful operation of a Management Services Organization (MSO), serving as the financial steward of the organization’s delegated risk and value-based care arrangements. MSOs operate in complex reimbursement environments—capitation, shared savings, risk adjustment, and quality incentives—where even small inaccuracies in data, payments, or assumptions can have significant financial consequences. This role ensures the organization maintains financial stability, meets regulatory obligations, and operates effectively under these reimbursement models. Requirements

MINIMUM & PREFERRED QUALIFICATIONS

Education/Training Minimum: Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, Finance, or related field. Experience Minimum: 5 years of progressive experience in healthcare finance, managed care analytics, or reimbursement within an MSO, Independent Physician Association (IPA), health plan, Accountable Care Organization (ACO), or large medical group. Hands‑on experience with capitation, medical expense analysis, risk adjustment (RAF/HCC), and value-based payment structures. Experience working with claims, encounter data, capitation files, eligibility files, and payer reporting. Background in financial modeling, budgeting, forecasting, and variance analysis. Preferred: 7+ years of managed care experience in delegated‑risk environments (Medicare Advantage, Medicaid managed care, and Commercial Health Maintenance Organization (HMO)). Experience leading or mentoring analysts or finance teams. Advanced expertise in financial modeling, capitation structures, and medical cost performance management. Demonstrated success leading cross‑functional teams in MSO or risk-bearing settings. Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration for this position. Certification(s) None. Skills, Knowledge & Abilities Deep understanding of managed care financial models, including capitation, PMPM revenue, shared savings, risk sharing, IBNR, risk adjustment, medical utilization and medical loss ratio (MLR) dynamics. Working knowledge of healthcare claims and encounter data, eligibility files, risk score methodologies (RAF/HCC), and reimbursement structures across Medicare Advantage, Commercial HMO, and Medicaid managed care. Familiarity with delegated‑risk requirements, health plan reporting standards, and compliance expectations set by the Centers for Medicare & Medicaid Services (CMS), Department of Managed Health Care (DMHC), and other regulatory bodies. Broad understanding of operational functions influencing managed care performance (e.g., utilization management, contracting, provider relations, revenue cycle, and claims operations). Ability to analyze large datasets, identify cost drivers, and translate complex financial trends into clear, actionable insights. Proficiency in financial planning tools and processes, including budgeting, forecasting, modeling, and variance analysis for capitation and medical expenses. Strong Excel skills and experience with analytics/reporting tools such as Power BI, Tableau, and SQL. Excellent leadership and people management skills, with the ability to motivate and develop staff in a high‑accuracy, high‑accountability environment. Exceptional communication skills, both written and verbal, with the ability to interact effectively with internal teams, external partners, and leadership, with a high regard for attention to detail. Ability to manage multiple priorities, meet deadlines, and work in a fast‑paced, compliance‑driven environment. Ability to maintain confidentiality and adhere to HIPAA regulations.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical, mental, and environmental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Work is primarily performed in a standard office or hybrid office environment and requires prolonged periods of sitting, frequent use of a computer, telephone, and video conferencing platforms, and sustained visual focus when reviewing eligibility records, enrollment data, reports, policies, and contracts. The role requires significant mental concentration, analytical thinking, and attention to detail when interpreting benefits, eligibility rules, capitation-related data, and regulatory requirements. The position may require occasional local travel to health plans, administrative offices, or organizational sites for meetings, audits, or collaborative work sessions, with occasional regional travel as needed. The employee must be able to lift, carry, push, or pull items up to approximately 20 pounds (e.g., laptop, files, binders, or work materials). This role requires adequate visual and auditory acuity to review written and electronic materials, analyze data and reports, and communicate effectively with staff, leadership, health plan representatives, and other internal and external stakeholders. The role may involve periods of high workload, time‑sensitive deadlines, and exposure to confidential or complex information requiring discretion, professionalism, and sound judgment.

SALARY RANGE

$115,000 - $135,000 / annually #J-18808-Ljbffr LSMA Management Inc