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Managed Care Analyst, Senior

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Location: Fountain Valley, California

Schedule: Full-time

Shift: Full-time

Job Listing: MEM004352

Purpose Statement / Position Summary

The Managed Care Analyst, Senior (MCA-S) supports senior management by preparing advanced reports, analysis and presentations from internal data sources.   As a liaison with other departments, the MCA-S ensures that Finance department needs are being addressed and met.  The MCA-S is an independent worker and performs the necessary collection and analysis of data to address questions from senior management and individuals outside the organization.  Key traits of this position are:  strong analytical skills, advanced data querying techniques, highly motivated, utilizes conventional and unconventional methods to solve problems and takes ownership of issues.

Essential Functions and Responsibilities of the Job
  • Self-sufficiently prepares detailed analyses, high level summaries and delivers presentation for Management, providing insights and trend information.
  • Creates queries to access and tabulate data in an efficient and reusable way.
  • Develops methods to discover anomalies and outliers
  • Predicts future trends; provides possible scenarios and recommendations.
  • Works with other departments on their ad hoc needs.
  • Manages his\her own projects, updating and sharing due dates, tasks, statuses and documentation.
  • Be at work and be on time.
  • Follow company policies, procedures and directives.
  • Interact in a positive and constructive manner.
  • Prioritize and multitask.

Essential Job Outcomes

  • Depending on reporting areas assigned, some or all of the following:
  • Health plan data/reports are carefully reviewed and a detailed analysis is prepared, which identifies trends in revenue, expenses and adjustments.Analysis is thorough and completed timely with little to no direction from supervisor.
  • Medical cost, utilization and physician trend reports are designed and presented to leadership in accordance with established deadlines and include a thorough and insightful analysis of trends.They are completed with little to no direction from supervisor.
  • Monthly reports are prepared accurately and timely and include a thorough analysis of expense fluctuations.Inquiries from providers and leadership regarding payments and reports are addressed quickly and accurately.The report preparation and inquiries are handled with little to no direction from supervisor.
  • IBNR model is created in accordance with established deadlines and a detailed analysis is completed which identifies trends in data and includes recommendations to management on appropriate reserves.This is completed with little to no direction from supervisor.
  • By-healthplan financial statements are prepared and thoroughly analyzed in accordance with established deadlines with minimal to no direction from supervisor.
  • Ad hoc reports are created in accordance with communicated expectations and include a thorough, insightful analysis and are completed with little to no direction from supervisor.
  • Collaborations with Business Intelligence department, health plans, Network Management department, etc. to strategize and design databases and queries are productive and achieve desired results.
  • Presentations to senior leadership are thorough, yet succinct, clearly address issues and exhibit professionalism and tact.
  • Proactively and independently identifies anomalies in data.Prepares and presents appropriate, actionable data and recommendations to leadership.
  • 'Other duties as assigned'
Experience
  • Minimum 5 years' experience, preferably in healthcare or managed care.
  • Experience using relational SQL databases, decision support systems, analysis and modeling.
  • Proficient in Excel, PowerPoint as well as other MS Office products


Education

  • Bachelor's degree in Business, Finance or Healthcare
  • Training in RDBs, SQL, Access and Excel required
 

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Photo of Brindilyn Berger
"I love working at Miller Children's & Women's Hospital Long Beach because I value working for a company that invests in its employees and the community we serve. From the support and guidance I receive from managers who value my professional and personal growth; to being able to work alongside colleagues who are dedicated to help their patients and families. I feel inspired every day to do the work that I love alongside people who share a similar vision."
- Brindilyn Berger, Child Life Specialist

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