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Company Contact Info
3250 Mary Street
Miami, FL 33133
- Giovanny Flores
- Phone: 305-448-8100
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HealthSun Health Plans • Miami, FL
Posted 27 days ago
Travel - None
Experience - 2 to 5 years
Degree - 4 Year Degree
Healthcare - Health Services
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HealthSun Health Plans www.healthsun.com is seeking energetic, talented and qualified professionals to join us in our mission of changing the healthcare experience of our members - making it easier, friendlier and more accessible. If you are looking for a challenging and rewarding career with a chance to make a real difference in your community, please apply.
HealthSun Health Plans is headquartered in the Coconut Grove area of Miami, Florida supporting the needs of Medicare Advantage recipients throughout South Florida. We are proud to offer outstanding career advancement opportunities, competitive salaries, paid holidays, medical & dental insurance plans, vacation/sick/personal time, and disability benefits.
The Medical Economics Financial Analyst is responsible for providing analytical support to the Medical Economics Manager by collecting, analyzing and interpreting health care data including but not limited to premium, claims, capitation, member, and provider information.
- Reconciles the Monthly CMS Premium Data with the Plans Data, verifying accuracy of membership and payment information.
- Prepares Financial Reports for Physician Meetings and Executive Meetings by extracting and manipulating required data.
- Validates and Reconciles monthly Encounter Claims Data for Capitated Specialist Providers.
- Creates savings opportunities through the review of current provider contracts and medical claims repricing analysis.
- Assists in Audit and Recovery efforts by analyzing claims payment discrepancies caused by member eligibility and enrollment information and/or provider capitated and FFS contract assignment.
- Performs AdHoc Reporting as required, summarizing results, identifying areas of opportunity, and providing actionable solutions and recommendations.
- Responsible for assisting in the improvement of assigned internal processes and the documentation of these required tasks.
- Communicates effectively with other professional and support staff in order to achieve positive customer outcomes.
- Promotes and contributes to a positive, problem-solving environment.
- Assists customers, family members and others with concern and empathy; respect their confidentiality and privacy and communicate with them in a courteous and respectful manner.
- Complies with company policies and procedures and maintains confidentiality of customer medical records in accordance with state and federal laws.
- Ensures compliance with all HIPAA, OSHA, and other federal, state, and local regulations.
- Participates in meetings, training and in-service education, as required.
- Performs other duties as assigned.
- Bachelor's degree in Business Administration with specialization in Accounting or Finance from an accredited college or university required
- Medicare Advantage Health Care knowledge and experience strongly preferred
- Minimum of 2 years’ experience manipulating Financial Data
- Proficiency using Microsoft Office, specifically Excel. This includes, but is not limited to, the ability to: create and manipulate Pivot Tables, perform V Lookups, create If Statements, and perform advanced formulas
- Ability to extract data from SQL Server Management Studio is preferred
- Demonstrates advanced analytical skills with strong attention to detail
- Excellent organization skills with the ability to work on time sensitive tasks, maintaining timeliness and accuracy
- Excellent listening, interpersonal, verbal and written communication skills with individuals at all levels of the organization
- Ability to work effectively independently and in a team environment
- Ability to read, analyze, and interpret technical procedures or governmental regulations
- Ability to write reports, business correspondence, and procedure manuals
- Ability to effectively present information and respond to questions from groups of managers, clients, customers and the general public
- Ability to calculate figures and amounts, such as discounts, interest, commissions, proportions, percentages, area and volume
- Ability to define problems, collect data, establish facts, and draw valid conclusions
- Strong decision-making, analytical skills
- Must be self-motivated, organized and have excellent prioritization skills
- Must be able to work well under stressful conditions
- Must be able to work in a fast paced environment
HealthSun Health Plans and its affiliated companies is an equal opportunity/affirmative action employer and complies with all federal and state laws, regulations and executive orders regarding affirmative action requirements in all programs. M/F/D/V.
HealthSun and its affiliates are also a drug-free workplace.
*Internal candidates must submit the Internal Application Form approved by his/her supervisor before interviewing with HR. Qualified candidates will be considered by the Hiring Manager.
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