Direct the analysis of product sales results; review financial data and prepare monthly and annual reports; provide insightful information and expectations to senior executives to aid in long-term and short-term decision making. Identify opportunities and execute programs that maximize revenue for State Sponsored programs while maintaining compliance with program requirements. Identify opportunities to improve medical costs, quality performance, network performance, operational performance and executes programs to achieve financial targets.
* Oversee the Government Programs P&L, and drive initiatives to ensure product performance.
* Oversee SSP recovery opportunities; monitors ongoing financial valuation and billing/correction of: underpayments resulting from eligibility gap errors, denied premiums, and kick payment recovery.
* Manage the implementation, program execution, and ongoing financial valuation activities for: SSP Inpatient Reinsurance, Mental Health Stop Loss, and Sick Baby/Low Birthweight Baby identification & disenrollment programs.
* Monitor SSP COB identification and recovery activities including financial valuation according to the SSP strategic plan; serve as subject expert on the SSP Steering committee for revenue maximization programs and participate in strategic planning for the SSP program to identify programs designed to maximize SDOH revenue.
* Work with business owners to identify opportunities to improve revenue, operational performance, quality measure performance, contracting and provider performance, and to reduce medical costs.
* Develop and drive the execution of strategies to improve revenue, operational performance, quality measure performance, contracting and provider performance, and reduce medical costs.
* Analyze financial results; deconstruct rate sheets; evaluate the impact to the P&L; perform financial modeling; and identify areas for product performance improvement.
* Develop performance metrics to build transparency into operational and financial performance of State Sponsored Programs. Analyze results, identify opportunities, areas for improvement, and strategies to optimize performance.
* Build relationships with DOH Finance staff and act as the liaison between SSP and internal finance/actuarial staff.
* Regular attendance is an essential function of the job. Perform other duties as assigned or required.
* Bachelor's degree in business, healthcare, operations, or analytical field, or related; Master's degree preferred
* Minimum of 10-12 years of relevant job experience required
* 7+ years' healthcare experience in positions designed to drive product performance, reduce costs, and increase efficiency and effectiveness of product offerings in the marketplace required
* Exceptional attention to detail, while retaining the ability to see the \"big picture\", and connect the dots between ideation, execution, and results required
* Ability to analyze data, root causes, trends, etc.; to understand and interpret data; to develop reports that convey potentially complex ideas in a manner that is comprehensible by all types and levels of audiences required
* Medicare and Medicaid Managed Care experience: enrollment, payment and risk adjustment reconciliation methodology for both programs required
* Strong data manipulation ability and experience with data analysis tools preferred
* Requisition ID: 1909Y
We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.
Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.
Associated topics: business, business analyst, consult, examiner, guidance, investment analyst, investment analytics, law, regulation, strategy