DaVita Manager, Healthcare Analytics in EL SEGUNDO, California

Manager, Healthcare Analytics

Description

DaVita Medical Group manages and operates medical groups and affiliated physician networks in California, Nevada, New Mexico, Florida, Colorado and Washington in its pursuit to deliver excellent-quality health care in a dignified and compassionate manner. As of June 30, 2016 DaVita Medical Group (formerly HealthCare Partners) provided integrated care management for approximately 760,000 patients. DaVita Medical Group’s leadership development initiatives and social responsibility efforts have been recognized by Fortune, Modern Healthcare, Newsweek and WorldBlu.

We are committed to bringing the benefits of coordinated care to our patients and to taking a leading role in the transformation of the national healthcare delivery system to assure quality, access, and affordable care for all.

If you're looking to make a difference with a large, financially stable, well-recognized medical group, DaVita Medical Group may be the employer for you.

OVERVIEW OF THE POSITION:

Responsible for a specified team of Financial Analysts and Auditors. Coordinates projects and manages the internal audit functions including the monitoring of claims payments, capitation revenue / deductions, risk pool, pharmacy, professional and institutional payments for accuracy, compliance and responsibility. Provides support to the management team in developing policies and procedures, assuring department product quality, mentoring, training, hiring and performance appraisals.

ESSENTIAL FUNCTIONS:

  • Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer.

  • Develops and maintains systems that allow for ease of data retrieval and manipulation from a variety of sources including claims payment, utilization management, health plan risk pools, subcontractor capitation, internal charges, subcontractor risk pools and others.

  • Audits and recovers claims overpayments, capitation revenue underpayments by the health plan (e.g., ESRD, Institutional), inappropriate risk pool expense deductions (HealthNet Aids and Transplants), and other areas identified as a cost benefit to direct audit and recovery efforts.

  • Assures accuracy and timeliness of subcapitation payments.

  • Develops systems to assure the timeliness if risk pool reconciliations.

  • Develops financial models for new ventures.

  • Performs historical studies to forecast future costs.

  • Develops subcapitation and risk pool models.

  • Develops models to evaluate provider contract proposals.

  • Identifies trends in claims expenses and recommends methods for reduction.

  • Coordinates requests for analysis from internal and external clients including assignment, mentoring and establishing timelines.

  • Performs research on industry performance measures for evaluation of client performance.

  • Develops departmental and individual goals.

  • Ensures accuracy and readability of for all team projects.

  • Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

  • Performs additional duties as assigned.

Qualifications

EDUCATION:

  • Bachelor’s degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college.

  • Master’s degree preferred.

EXPERIENCE:

Minimum:

  • Over 3 years and up to and including 5 years of healthcare experience.

  • Supervisory experience.

Preferred:

  • 2 or more years experience in a managed healthcare organization.

  • 4 or more years of analytical, financial and/or accounting experience (2 years of which are substitutable by a graduate degree).

KNOWLEDGE, SKILLS, ABILITIES:

  • Computer literate.

  • Proficient in Microsoft Office applications (Word, Excel, Access).

  • Excellent verbal and written communication skills.

Primary Location CA-EL SEGUNDO - 90245

Req ID: 308797