Finance Program Manager (Performance Analytics)

Role Description

The Population Health Finance Program Manager for Performance Analytics leads analysis on Population Health data sets and programs. This role focuses on program financial performance at a ACO, TIN and NPI level to include MSSP (Medicare Shared Savings Program) and Medicare Advantage. This role works with the external actuarial consulting team, other vendors, internal finance, IT/analytics, and brings strong knowledge of healthcare data sets.

The role requires experience working in health insurance, value-based care contracting, Accountable Care Organizations (ACOs), Clinically Integrated Networks (CINs), and other risk-based health care delivery due to the complexity and knowledge level required for success. It requires prior experience working in Medicare CCLFs and building out custom analyses in Excel and other tools.

The role supports forecasting and scenario modeling, and ensures the accuracy and integrity of financial datasets. The role translates actuarial and management guidance into financial forecasting across the entities to optimally grow PH operating performance while remaining compliant with appropriate financial and operating BSMH controls.

Essential Job Functions

• Evaluates and translates performance in full risk arrangements, including Medicare and Medicare Advantage programs, into financial guidance; tracks performance under all value-based arrangements attributed to PH, bundled payment and shared savings program methodologies.
• Analyze claims, eligibility, and contractual data from CMS and Payers to identify financial trends, risks, and opportunities.
• Studies statistical data to create an analysis; estimates of probability, benchmarks and likely costs for a segment or population.
• Uses PH tools, claims and eligibility and attribution data and other reporting systems and sources to provide clinical, financial, utilization, and claims analytics.
• Develops trend analysis reports that monitor key performance indicators and compares them to internal and external benchmarks; uses this data to assist leadership in decision-making, planning and implementing performance improvement strategies.
• Sets targets by TINs, providers, markets, and reports against target vs. actual performance, working with our ACO/CIN network team.
• Serves as a hands-on analyst to review workflows and documentation.
• Perform routine audits and analytics for existing value-based programs to validate attribution, quality performance and financial reconciliations; monitors internal controls and makes recommendations for improvements, including coordinating across BSMH Internal Audit, third-parties, other internal stakeholders.
• Ensure HIPAA compliance, adherence to data governance standards, and protection of PHI.
• Provide ad hoc analyses to support financial planning, vendor performance reviews, and strategic initiatives.

Qualifications

• Bachelor’s degree in Health Informatics, Data Analytics, Accounting, or related field (required)
• Master’s degree in Business Administration, Finance, Health Informatics, or related discipline (preferred)

Requirements

• 5-10 years in healthcare finance/accounting and analytics
• Proficiency in SQL, Tableau, Excel, and familiarity with relational database
• Specific Knowledge and Experience Working in:
• Medicare CCLFs and Payer Claims files
• Working in Milliman Medinsight and/or other claims-based data warehouses
• Working in Epic (preferred, not required) data with IT support
• For MSSP, experience with:
• CCLF summary analysis
• Claims analysis
• BDCA early insights indicators
• TIN and NPI level performance
• For MA, experience with:
• Payer claims analysis
• Reconciliation report analysis
• Star Rating forecasting and analysis
• TIN and NPI level performance

Benefits

• Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
• Medical, dental, vision, prescription coverage, HSA/FSA options, life insurances, mental health resources and discounts
• Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
• Tuition assistance, professional development and continuing education support
• Benefits may vary based on the market and employment status.